Information Collection

Request for Waiver of Service Obligation

IC 229401 under ICR 202505-2133-001 · OMB 2133-0510.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form MA-935 Request for Waiver of Service Obligation	Form and Instruction
Form MA-935 Request for Waiver of Service Obligation Request for Waiver of Service Obligation	Form and Instruction
MA-935 Request for Waiver of Service Obligation MA-935-Request for Waiver of Service Obligation V2 5.15.2025.pdf	Form and Instruction
MA-935 Request for Waiver of Service Obligation MA-935-Request for Waiver of Service Obligation V2 5.15.2025.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

2133-0510

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

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	MA-935				Yes	Yes	Fillable Fileable Signable

Line of Business: Transportation

Subfunction: Water Transportation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 5

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	Previously Approved
Annual Number of Responses for this IC	5	0	5
Annual IC Time Burden (Hours)	1	-2	3
Annual IC Cost Burden (Dollars)	0	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.

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