Uniform Report of DBE Awards or Commitments and Payments Form

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OMB CONTROL NUMBER: 2105-0586
EXPIRATION DATE: (5/31/2027)

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 21050586. Public reporting for this collection of information is estimated to be approximately 317 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 under 49 CFR § 26.11; the nature and extent
of confidentiality to be provided, if any under 49 CFR §§ 26.109(b). Send comments regarding this
burden estimate or any other aspect of this collection of information, including suggestions for reducing
this burden to: Information Collection Clearance Officer, Departmental Office of Civil Rights, 1200 New
Jersey Ave, Washington, D.C. 20590.
Privacy Act Statement (5 U.S.C. § 552a, as amended):
AUTHORITY : 42 U.S.C. 2000d et seq., § 12101 et seq., 42 U.S.C. 6101 et seq.; 29 U.S.C. 794, 749d; 49
U.S.C. 47113; 42 U.S.C. 12101; 49 CFR Part 23; 49 CFR Part 26, and Executive Order 13160.
PURPOSE(S): DOT will use the information collected to respond to Disadvantaged Business Enterprise
(DBE) and Airport Concession Disadvantaged Business Enterprise (ACDBE) inquiries and adjudicate
appeals.
ROUTINE USE(S): In accordance with DOT’s system of records notice, DOT/ALL–24 Departmental
Office of Civil Rights, 76 FR 71108 (Nov. 16, 2011), the information provided may be disclosed to the U.
S. Department of Justice, including United States Attorney’s Offices, or other Federal agency conducting
litigation or in proceedings before any court, adjudicative or administrative body, when it is necessary to
the litigation and one of the following is a party to the litigation or has an interest in such litigation. A
comprehensive list of routine uses can be found in DOT/ALL 24 and DOT’s General Statement of
Routine uses, 75 FR 82138 (Dec. 29, 2010). 77 FR 42796 (July 20, 2012), 84 FR 55222
(Oct. 15, 2019).

Uniform Report of DBE Awards or Commitments and Payments Form
INSTRUCTIONS FOR COMPLETING THE UNIFORM REPORT OF DBE
AWARDS/COMMITMENTS AND PAYMENTS
Recipients of Department of Transportation (DOT) funds are expected to keep accurate data regarding the
contracting opportunities available to firms paid for with DOT dollars. Failure to submit contracting data
relative to the DBE program will result in noncompliance with Part 26. All dollar values listed on this
form should represent the DOT share attributable to the Operating Administration (OA): Federal
Highway Administration (FHWA), Federal Aviation Administration (FAA) or Federal Transit
Administration (FTA) to which this report will be submitted. Forms shown below are examples only.
Reports must be submitted at the intervals required by, and in the format acceptable to, the Operating
Administration concerned.
1. Indicate the DOT (OA) that provides your Federal financial assistance. If assistance comes from more
than one OA, use separate reporting forms for each OA. If you are an FTA recipient, indicate your
Vendor Number in the space provided.
2. If you are an FAA recipient, indicate the relevant AIP Numbers covered by this report. If you are an
FTA recipient, indicate the Grant/Project numbers covered by this report. If more than ten attach a
separate sheet.
3. Specify the Federal fiscal year (i.e., October 1-September 30) in which the covered reporting period
falls.
4. State the date of submission of this report.
5. Check the appropriate box that indicates the reporting period that the data provided in this report
covers. For FHWA and FTA recipients, if this report is due June 1, data should cover October 1-March
31. If this report is due December 1, data should cover April 1-September 30. If the report is due to the
FAA, data should cover the entire fiscal year.
6. Provide the name and address of the recipient.
7. State your overall DBE goal(s) established for the Federal fiscal year of the report being submitted to
and approved by the relevant OA. Your overall goal is to be reported as well as the breakdown for
specific DBE Conscious and DBE Neutral projections. The DBE Conscious projection should be based
on measures that focus on and provide benefits only for DBEs. The use of contract goals is a primary
example of a DBE Conscious measure. The DBE Neutral projection should include measures that, while
benefiting DBEs, are not solely focused on DBE firms. For example, a small business outreach program,
technical assistance, and prompt payment clauses can assist a wide variety of businesses in addition to
helping DBE firms.
Section A: Awards and Commitments Made During This Period
The amounts in items 8(A)-10(I) should include all types of prime contracts awarded and all types of
subcontracts awarded or committed, including: professional or consultant services, construction, purchase
of materials or supplies, lease or purchase of equipment and any other types of services. All dollar
amounts are to reflect only the Federal share of such contracts and should be rounded to the nearest
dollar.
Line 8: Prime contracts awarded this period: The items on this line should correspond to the contracts
directly between the recipient and a supply or service contractor, with no intermediaries between the two.

8(A). Provide the total dollar amount for all prime contracts assisted with DOT funds and awarded during
this reporting period. This value should include the entire Federal share of the contracts without removing
any amounts associated with resulting subcontracts.
8(B). Provide the total number of all prime contracts assisted with DOT funds and awarded during this
reporting period.
8(C). From the total dollar amount awarded in item 8(A), provide the dollar amount awarded in prime
contracts to certified DBE firms during this reporting period. This amount should not include the amounts
subcontracted to other firms.
8(D). From the total number of prime contracts awarded in item 8(B), specify the number of prime
contracts awarded to certified DBE firms during this reporting period.
8(E&F). This field is closed for data entry. DBE Neutral BE Neutral BE Neutral
8(G). From the total dollar amount awarded in item 8(C), provide the dollar amount awarded to certified
DBEs through the use of DBE Neutral methods. See the definition of DBE Neutral in item 7 and the
explanation in item 8 of project types to include.
8(H). From the total number of prime contracts awarded in 8(D), specify the number awarded to DBEs
through DBE Neutral methods.
8(I). Of all prime contracts awarded this reporting period, calculate the percentage going to DBEs. Divide
the dollar amount in item 8(C) by the dollar amount in item 8(A) to derive this percentage. Round the
percentage to the nearest tenth.
Line 9: Subcontracts awarded/committed this period: Items 9(A)-9(I) are derived in the same way as
items 8(A)-8(I), except that these calculations should be based on subcontracts rather than prime
contracts. Unlike prime contracts, which may only be awarded, subcontracts may be either awarded or
committed.
9(A). If you fill out the form for general reporting, provide the total dollar amount of subcontracts
assisted with DOT funds awarded or committed during this period. This value should be a subset of the
total dollar awarded in prime contracts in 8(A) and therefore should never be greater than the amount
awarded in prime contracts. If filling out the form for project reporting, provide the total dollar amount of
subcontracts assisted with DOT funds awarded or committed during this period. This value should be a
subset of the total dollars awarded or previously in prime contracts in 8(A). The sum of all subcontract
amounts in consecutive periods should never exceed the sum of all prime contract amounts awarded in
those periods.
9(B). Provide the total number of all subcontracts assisted with DOT funds that were awarded or
committed during this reporting period.
9(C). From the total dollar amount of subcontracts awarded/committed this period in item 9(A), provide
the total dollar amount awarded in subcontracts to DBEs.
9(D). From the total number of subcontracts awarded or committed in item 9(B), specify the number of
subcontracts awarded or committed to DBEs.

9(E). From the total dollar amount of subcontracts awarded or committed to DBEs this period, provide
the amount in dollars to DBEs using DBE Conscious measures.
9(F). From the total number of subcontracts awarded or committed to DBEs this period, provide the
number of subcontracts awarded or committed to DBEs using DBE Conscious measures.
9(G). From the total dollar amount of subcontracts awarded/committed to DBEs this period, provide the
amount in dollars to DBEs using DBE Neutral measures.
9(H). From the total number of subcontracts awarded/committed to DBEs this period, provide the number
of subcontracts awarded to DBEs using DBE Neutral measures.
9(I). Of all subcontracts awarded this reporting period, the percentage going to DBEs calculate. Divide
the dollar amount in item 9(C) by the dollar amount in item 9(A) to derive this percentage. Round the
percentage to the nearest tenth.
Line 10: Total contracts awarded or committed this period. These fields should be used to show the total
dollar value and number of contracts awarded to DBEs and to calculate the overall percentage of dollars
awarded to DBEs.
10(A)-10(B). These fields are unavailable for data entry.
10(C-H). Combine the total values listed on the prime contracts line (Line 8) with the corresponding
values on the subcontracts line (Line 9).
10(I). Of all contracts awarded this reporting period, calculate the percentage going to DBEs. Divide the
total dollars awarded to DBEs in item 10(C) by the dollar amount in item 8(A) to derive this percentage.
Round the percentage to the nearest tenth.
Section B: Payments on Ongoing Contracts

Line 18(A-E). Submit information on contracts that are currently in progress. All dollar amounts
are to reflect only the Federal share of such contracts and should be rounded to the nearest dollar.
18(A). Provide the total number of prime contracts where work was performed during the
reporting period.

18(B). Provide the total dollars paid to prime contractors for work performed on contracts during
the reporting period. Payments by recipients for all work performed on the contract are made to
the prime contractor, who in turn is obligated to promptly pay its DBE and non-DBE
subcontractors. See 49 C.F.R. §26.29.
18(C). Provide the total number of prime and subcontracts that are currently being performed by
DBE firms for which payments have been made. The number of contracts reported in item
18(C) may be larger, smaller, or the same as the number in item 18(A).
For example, assume that only one prime contract is underway during the reporting
period:
If the prime contractor is a non-DBE with 3 DBE subcontractors, the number reported in
item 18(C), will be higher than item 18(A).
If a non-DBE prime contract reported in item 18(A) has no DBE subcontractors, the
number reported in item 18(C) will be less than item 18(A).
If the prime contract involves a DBE prime contractor with no DBE subcontractors, the
number in item 18(A) and item 18(C) would be the same, with appropriate notation that
item 18(C) includes a DBE prime contract.
18(D). Provide the total dollar amount paid to DBE firms currently performing work during this
reporting period. If the prime contractor is a DBE, report only the total dollars paid to the DBE
prime contractor who in turn is obligated to promptly pay its DBE subcontractors.
18(E). Provide the total number of DBE firms that received payment during this reporting period.
For example, while 3 contracts may be active during this period, one DBE may be providing
supplies or services on all three contracts. This field should only list the number of DBEs
performing work.
18(F). Of all payments made during this period, calculate the percentage going to DBEs. Divide
the total dollar value to DBEs in item 18(D) by the total dollars of all payments in item 18(B).
Round the percentage to the nearest tenth.
Section C: Actual Payments on Contracts Completed This Reporting Period
This section should provide information only on contracts that are closed during this period. All dollar
amounts are to reflect the entire Federal share of such contracts and should be rounded to the nearest
dollar.
19(A). Provide the total number of contracts completed during this reporting period that use DBE
Conscious measures. DBE Conscious contracts are those with contract goals or another DBE
Conscious measure.
19(B). Provide the total dollar value of prime contracts completed this reporting period that had
DBE Conscious measures.

19(C). From the total dollar value of prime contracts completed this period in 19(B), provide the total
dollar amount of dollars awarded or committed to DBE firms in order to meet the contract goals. This
applies only to DBE Conscious contracts.
19(D). Provide the actual total DBE participation in dollars on the DBE Conscious contracts completed
this reporting period.
19(E). Of all the contracts completed this reporting period using DBE Conscious measures, calculate the
percentage of DBE participation. Divide the total dollar amount to DBEs in item 19(D) by the total dollar
value provided in 19(B) to derive this percentage. Round to the nearest tenth.
20(A)-20(E). Items 21(A)-21(E) are derived in the same manner as items 19(A)-19(E), except these
figures should be based on contracts completed using DBE Neutral measures.
20(C). This field is closed.
21(A)-21(D). Calculate the totals for each column by adding the DBE Conscious and DBE Neutral figures
provided in each row above.
21(C). This field is closed.
21(E). Calculate the overall percentage of dollars to DBEs on completed contracts. Divide the Total DBE
participation dollar value in 21(D) by the Total Dollar Value of Contracts Completed in 21(B) to derive
this percentage. Round to the nearest tenth.
22. Name of the Authorized Representative preparing this form.
23. Signature of the Authorized Representative.
24. Phone number of the Authorized Representative.

DISCLAIMER: All responses to this collection of information are mandatory under 49 CFR § 26.11.

UNIFORM REPORT OF DBE COMMITMENTS/AWARDS AND PAYMENTS
1 Submitted to (check only one)
2 AIP Numbers (FAA Recipients);
Grant Number (FTA Recipients):
Federal Fiscal year in which reporting
3 period falls
5 Reporting Period
6 Name and address of Recipient:
7 Annual DBE Goal(s):

FHWA

**Please refer to the instruction sheet for directions on filling out this form**
FAA
FTA - Recipient ID Number

FY
Report due June 1 (for period Oct 1-Mar 31)

4. Date This Report Submitted:
Report due Dec 1 (for period April 1-Sep 30)

DBE Conscious Projection:

FAA annual report due Dec 1

DBE Neutral Projection:

OVERALL Goal:

Awards/Commitments this Reporting Period

A

A
Total Dollars

AWARDS/COMMITMENTS
MADE DURING THIS
REPORTING PERIOD

B
Total Number

C

D

Total to DBEs
(dollars)

Total to DBEs
(number)

E

F

Total to DBEs/DBE Total to DBEs/DBE
Conscious (dollars)
Conscious
(number)

(Total contracts and subcontracts
committed during this reporting
period)

8 Prime contracts awarded this period
Subcontracts awarded/committed this
9 period
10 TOTAL

$

$

$

$
$

G

H

I

Total to
DBEs/DBE
Neutral
(dollars)

Total to
DBEs/DBE
Neutral
(number)

Percentage
of total
dollars to
DBEs

$

0

0

$
$

0

0

$
$

0.0%

0.0%
0

0

0.0%

Payments Made this Period

B

PAYMENTS ON ONGOING
CONTRACTS

A

B

C

D

E

F

Total Number of
Prime Contracts

Total Dollars Paid

Total Number
of Prime and
Subcontracts
with DBEs

Total Payments to DBE firms

Total Number of DBE
firms Paid

Percent to
DBEs

Prime and subcontracts currently in
18 progress

C

TOTAL PAYMENTS ON
CONTRACTS COMPLETED THIS
REPORTING PERIOD
19 DBE Conscious
20 DBE Neutral
21 Totals
22 Submitted by:

$

$

0.0%

A

B

D

E

Number of Contracts Completed

Total Dollar Value of Contracts
Completed

DBE Participation Needed to Meet
Goal (Dollars)

Total DBE Participation
(Dollars)

Percent to
DBEs

$
$
$

$

$
$
$

0

23. Signature:

C

0

24. Phone Number:

0.0%

0

0.0%
0.0%