Active Participant List

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: dbe_finalrule@dot.gov
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