Information Collection

WB-AWARD-Individual with Legal Representative

IC 262370 under ICR 202412-2127-008 · OMB 2127-0767.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form NHTSA Form 1686 WB-AWARD-Individual with Legal Representative	Form and Instruction
Form NHTSA Form 1686 FORM WB-AWARD WHISTLEBLOWER AWARD APPLICATION WB-AWARD-Individual with Legal Representative	Form and Instruction
NHTSA Form 1686 FORM WB-AWARD WHISTLEBLOWER AWARD APPLICATION Form WB-AWARD WHISTLEBLOWER AWARD APPLICATION.docx	Form and Instruction
NHTSA Form 1686 FORM WB-AWARD WHISTLEBLOWER AWARD APPLICATION Form WB-AWARD WHISTLEBLOWER AWARD APPLICATION.docx	Form and Instruction

IC Title:

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:

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	NHTSA Form 1686				Yes	Yes	Fillable Fileable Signable

Line of Business: Transportation

Subfunction: Ground Transportation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2	2
Annual IC Time Burden (Hours)	20	20
Annual IC Cost Burden (Dollars)	10,640	10,640

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.

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