Active Participant List

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OMB CONTROL NUMBER: 2105-0586
EXPIRATION DATE: mm/dd/yyyy
Active Participants List
Paperwork Reduction Act Burden Statement
A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be
subject to a penalty for failure to comply with a collection of information subject to the requirements of the
Paperwork Reduction Act unless that collection of information displays a currently valid OMB Control Number. The
OMB Control Number for this information collection is 2105-0586. Public reporting for this collection of information
is estimated to be approximately 42 hours per response, including the time for reviewing instructions, searching
existing data sources, gathering and maintaining the data needed, completing and reviewing the collection of
information.
All responses to this collection of information are mandatory (49 CFR § 23.37); the nature and extent of
confidentiality to be provided, if any (49 CFR § 26.109). Send comments regarding this burden estimate or any other
aspect of this collection of information, including suggestions for reducing this burden to: [email protected]

Active Participants List
Firm name
Name:

Firm Address
Street:
City:
State:
Zip Code:

ACDBE / non-ACDBE
ACDBE
Non-ACDBE

NAICS Code Applicable to Concessions
NAICS Code:

Age of the firm
No. of Years:

Annual gross receipts of the firm.
< $1,000,000
$1,000,000 - $3,000,000
$3,000,000 - $6,000,000
$6,000,000 - $10,000,000
$10,000,000 - $20,000,000
> $20,000,000