Information Collection

WB-INFO- Individual with Legal Representative

IC 262367 under ICR 202412-2127-008 · OMB 2127-0767.

Documents and Forms

Document Name Document Type
Form NHTSA Form 1684 WB-INFO- Individual with Legal Representative 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 with Legal Representative	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 513

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)	500	500
Annual IC Cost Burden (Dollars)	266,000	266,000

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.