Information Collection

Small Business Intake

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

Documents and Forms

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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Small Business Intake	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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	DOT F 4500	SBTTAC Intake Form	DOT_F_4500_SBTRC_Field_Office_Intake_Form_Final_V1.pdf		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 %

	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

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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