Information Collection

WB-INFO-Individual

IC 262366 under ICR 202412-2127-008 · OMB 2127-0767.

Documents and Forms

Document Name Document Type
Form NHTSA Form 1684 WB-INFO-Individual Form and Instruction
NHTSA Form 1684 FORM WB-INFO WHISTLEBLOWER SUBMISSION Form WB-INFO WHISTLEBLOWER SUBMISSION.docx Form and Instruction
NHTSA Form 1684 FORM WB-INFO WHISTLEBLOWER SUBMISSION Form WB-INFO WHISTLEBLOWER SUBMISSION.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	WB-INFO-Individual	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 49 CFR Part 513 (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	NHTSA Form 1684	FORM WB-INFO WHISTLEBLOWER SUBMISSION	Form WB-INFO WHISTLEBLOWER SUBMISSION.docx		Yes	Yes	Fillable Fileable Signable

Line of Business: Transportation

Subfunction: Ground Transportation

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 25	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	25	25
Annual IC Time Burden (Hours)	250	250
Annual IC Cost Burden (Dollars)	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.