WB-INFO-Individual

Whistleblower Program Forms

Documents and Forms

Document Name Document Type
Form NHTSA Form 1684 WB-INFO-Individual Form and Instruction
NHTSA Form 1684 FORM WB-INFO WHISTLEBLOWER SUBMISSION WB-INFO Form (Appendix A to Part 513).docx Form and Instruction
NHTSA Form 1684 FORM WB-INFO WHISTLEBLOWER SUBMISSION WB-INFO Form (Appendix A to Part 513).docx Form and Instruction

Information Collection (IC) Details

IC Title:	WB-INFO-Individual	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	NHTSA Form 1684	FORM WB-INFO WHISTLEBLOWER SUBMISSION	WB-INFO Form (Appendix A to Part 513).docx		Yes	Yes	Fillable Fileable Signable

Line of Business: Transportation

Subfunction: Ground Transportation

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 25	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	25	25
Annual IC Time Burden (Hours)	250	250
Annual IC Cost Burden (Dollars)	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.