Information Collection

IC-4: Performance Benchmark Certifications

IC 250990 under ICR 202403-2126-002 · OMB 2126-0075.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2126-0075 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Form 4 IC-4: Performance Benchmark Certifications	Form and Instruction
Form Form 4 IC-4: Performance Benchmark Certifications	Form and Instruction
Form 4 Probation Period 1 Benchmark Certification Attachment I_SafeDriverAPP_Probation Period 1_BenchmarkCert.docx	Form and Instruction
Form 4 Probation Period 1 Benchmark Certification Attachment I_SafeDriverAPP_Probation Period 1_BenchmarkCert.docx	Form and Instruction
Form 5 Probation Period 2 Benchmark Certification Attachment J_SafeDriverAPP_Probation Period 2_BenchmarkCert.docx	Form and Instruction
Form 5 Probation Period 2 Benchmark Certification Attachment J_SafeDriverAPP_Probation Period 2_BenchmarkCert.docx	Form and Instruction

IC Title:

IC-4: Performance Benchmark Certifications

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Form 4	Probation Period 1 Benchmark Certification	Attachment I_SafeDriverAPP_Probation Period 1_BenchmarkCert.docx		Yes	Yes	Fillable Printable
Form and Instruction	Form 5	Probation Period 2 Benchmark Certification	Attachment J_SafeDriverAPP_Probation Period 2_BenchmarkCert.docx		Yes	Yes	Fillable Printable

Line of Business: Transportation

Subfunction: Ground Transportation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,000

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	3,200	3,200
Annual IC Time Burden (Hours)	800	800
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.