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IC-3: Experienced Driver Information Form & Informed Consent Form
Safe Driver Apprenticeship Pilot Program
OMB: 2126-0075
IC ID: 250989
OMB.report
DOT/FMCSA
OMB 2126-0075
ICR 202408-2126-002
IC 250989
( )
Documents and Forms
Document Name
Document Type
Form Form 3
IC-3: Experienced Driver Information Form & Informed Consent Form
Form and Instruction
Form 3 Experienced Driver Application
Attachment G_SafeDriverAPP_Experienced Driver_Information Form.docx
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
IC-3: Experienced Driver Information Form & Informed Consent Form
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Unchanged
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
29 CFR 29
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
Form 3
Experienced Driver Application
Attachment G_SafeDriverAPP_Experienced Driver_Information Form.docx
Yes
Yes
Fillable Printable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Transportation
Subfunction:
Ground Transportation
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
2,730
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits
Percentage of Respondents Reporting Electronically:
0 %
Requested
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
2,730
0
0
0
0
2,730
Annual IC Time Burden (Hours)
910
0
0
0
0
910
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
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.