Information Collection

Small Business Intake

IC 203950 under ICR 202605-2105-001 · OMB 2105-0554.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form DOT F 4500 SBTTAC Intake Form Small Business Intake	Form
DOT F 4500 SBTTAC Intake Form DOT_F_4500_SBTRC_Field_Office_Intake_Form_Final_V1.pdf	Form

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 parts 23 and 26 (To search for a specific CFR, visit the Code of Federal Regulations.)

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	DOT F 4500				Yes	Yes	Fillable Printable

Line of Business: Transportation

Subfunction: Ground Transportation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,521

Number of Respondents for Small Entity: 100

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	2,521	2,421	100
Annual IC Time Burden (Hours)	3,782	3,632	150
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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