Request for Comments of a Previously Approved Information Collection(s), 40117-40140 [2018-17301]

Download as PDF sradovich on DSK3GMQ082PROD with NOTICES Federal Register / Vol. 83, No. 156 / Monday, August 13, 2018 / Notices Federal Register by the Paperwork Reduction Act of 1995. DATES: Please submit comments by October 12, 2018. ADDRESSES: You may submit comments identified by DOT Docket ID 2018–0041 by any of the following methods: Website: For access to the docket to read background documents or comments received go to the Federal eRulemaking Portal: Go to https:// www.regulations.gov. Follow the online instructions for submitting comments. Fax: 1–202–493–2251. Mail: Docket Management Facility, U.S. Department of Transportation, West Building Ground Floor, Room W12–140, 1200 New Jersey Avenue SE, Washington, DC 20590–0001. Hand Delivery or Courier: U.S. Department of Transportation, West Building Ground Floor, Room W12–140, 1200 New Jersey Avenue SE, Washington, DC 20590, between 9 a.m. and 5 p.m. ET, Monday through Friday, except Federal holidays. FOR FURTHER INFORMATION CONTACT: Melissa Corder, 202–366–5853, melissa.corder@dot.gov; Office of Real Estate Services, Federal Highway Administration, Department of Transportation, New Jersey Avenue SE., Washington, DC 20590–0001. Office hours are from 6:15 a.m. to 3:45 p.m., Monday through Friday, except Federal holidays. SUPPLEMENTARY INFORMATION: Title: Fixed Residential Moving Cost Schedule. Background: Relocation assistance payments to owners and tenants who move personal property for a Federal or federally-assisted program or project are governed by the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970, as amended (Uniform Act). 49 Code of Federal Regulations (CFR), part 24, is the implementing regulation for the Uniform Act. 49 CFR 24.301 addresses payments for actual and reasonable moving and related expenses. The fixed residential moving cost schedule is an administrative alternative to reimbursement of actual moving costs. This option provides flexibility for the agency and affected property owners and tenants. The FHWA requests the State Departments of Transportation (State DOTs) to analyze moving cost data periodically to assure that the fixed residential moving cost schedules accurately reflect reasonable moving and related expenses. The regulation allows State DOTs flexibility in determining how to collect the cost data in order to reduce the burden of government regulation. Updated State VerDate Sep<11>2014 20:42 Aug 10, 2018 Jkt 244001 fixed residential moving costs are submitted to the FHWA electronically. Respondents: State Departments of Transportation (52, including the District of Columbia and Puerto Rico). Frequency: Once every 3 years. Estimated Average Burden per Response: 24 hours per respondent. Estimated Total Annual Burden Hours: 24 hours for each of the 52 State Departments of Transportation. The total is 1,248 burden hours, once every 3 years, or 416 hours annually. Public Comments Invited: You are asked to comment on any aspect of this information collection, including: (1) Whether the proposed collection is necessary for the FHWA’s performance; (2) the accuracy of the estimated burdens; (3) ways for the FHWA to enhance the quality, usefulness, and clarity of the collected information; and (4) ways that the burden could be minimized, including the use of electronic technology, without reducing the quality of the collected information. The agency will summarize and/or include your comments in the request for OMB’s clearance of this information collection. Authority: The Paperwork Reduction Act of 1995; 44 U.S.C. Chapter 35, as amended; and 49 CFR 1.48. Issued On: August 7, 2018. Michael Howell, Information Collection Officer. [FR Doc. 2018–17314 Filed 8–10–18; 8:45 am] BILLING CODE 4910–22–P DEPARTMENT OF TRANSPORTATION [Docket No. DOT–OST–2018–0075] Request for Comments of a Previously Approved Information Collection(s) Office of the Secretary, DOT. Notice and request for comments. AGENCY: ACTION: In accordance with the Paperwork Reduction Act of 1995, this notice announces that the Information Collection Request (ICR) abstracted below is being forwarded to the Office of Management and Budget (OMB) for review and comment. A Federal Register Notice with a 60-day comment period soliciting comments on the information collection was published on June 4, 2018. One comment was received that does not warrant any adjustments to the forms. DATES: Comments must be submitted on or before September 12, 2018. ADDRESSES: Send comments regarding the burden estimate, including suggestions for reducing the burden, to SUMMARY: PO 00000 Frm 00137 Fmt 4703 Sfmt 4703 40117 the Office of Management and Budget, Attention: Desk Officer for the Office of the Secretary of Transportation, 725 17th Street NW, Washington, DC 20503. Comments are invited on: Whether the proposed collection of information is necessary for the proper performance of the functions of the Department, including whether the information will have practical utility; the accuracy of the Department’s estimate of the burden of the proposed information collection; ways to enhance the quality, utility and clarity of the information to be collected; and ways to minimize the burden of the collection of information on respondents, including the use of automated collection techniques or other forms of information technology. FOR FURTHER INFORMATION CONTACT: Mr. Marc Pentino, Departmental Office of Civil Rights, Office of the Secretary, U.S. Department of Transportation, 1200 New Jersey Avenue SE, Washington, DC 20590, (202) 366–6968, or at marc.pentino@dot.gov. SUPPLEMENTARY INFORMATION: Title: Disadvantaged Business Enterprise Program Collections. OMB Control Number: 2105–0510. Type of Request: Renewal of a Previously Approved Information Collection. Abstract: The following information collections are associated with the U.S. Department of Transportation’s (DOT) Disadvantaged Business Enterprise (DBE) program: Uniform Report of DBE Awards or Commitments and Payments, Uniform Certification Application Form, Annual Affidavit of No Change, DOT Personal Net Worth Form, and Reporting Requirements for Percentages of DBEs in Various Categories. All five collections were previously approved under one OMB Control Number (2105– 0510) to allow DOT to more efficiently administer the DBE program. The DBE program is mandated by statute, including Section 1101(b) of the Fixing America’s Surface Transportation Act (FAST Act) (Pub. L. 114–94) and 49 U.S.C. 47113. DOT’s final regulations implementing these statutes are 49 CFR parts 23 and 26. The information to be collected is necessary because it helps to ensure that State and local recipients that let federally-funded contracts carry out their mandated responsibility to provide a level playing field for small businesses owned and controlled by socially and economically disadvantaged individuals. Uniform Report of DBE Awards/ Commitments and Payments Affected Public: DOT financiallyassisted State and local transportation agencies. E:\FR\FM\13AUN1.SGM 13AUN1 40118 Federal Register / Vol. 83, No. 156 / Monday, August 13, 2018 / Notices Frequency: Once per year. Number of Responses: One. Total Annual Burden: 57,698 hours. Number of Respondents: 1,250. Frequency: Once/twice per year. Number of Responses: One/two. Total Annual Burden: 9,000 hours. Uniform Certification Application Form Affected Public: Firms applying to be certified as DBEs. Number of Respondents: 9,500. Frequency: Once during initial certification. Number of Responses: One. Total Annual Burden: 76,000 hours. sradovich on DSK3GMQ082PROD with NOTICES Annual Affidavit of No Change Affected Public: Certified DBEs. Number of Respondents: Approximately 38,465 certified DBE firms. VerDate Sep<11>2014 20:42 Aug 10, 2018 Jkt 244001 Personal Net Worth Form Affected Public: Firms applying to be DBEs. Number of Respondents: 9,500. Frequency: Once. Number of Responses: One. Total Annual Burden: 19,000 hours. Percentage of DBEs in Various Categories Affected Public: States (through their Unified Certification Programs). PO 00000 Frm 00138 Fmt 4703 Sfmt 4703 Number of Respondents: 53 (50 states, plus the District of Columbia, Puerto Rico, and the Virgin Islands). Frequency: Once per year. Number of Responses: One. Total Annual Burden: 161.6 hours. Authority: The Paperwork Reduction Act of 1995; 44 U.S.C. Chapter 35, as amended; and 49 CFR 1:48. Issued in Washington, DC. Charles E. James, Sr., Director, Departmental Office of Civil Rights, U.S. Department of Transportation. BILLING CODE 4910–9X–P E:\FR\FM\13AUN1.SGM 13AUN1 40119 Federal Register / Vol. 83, No. 156 / Monday, August 13, 2018 / Notices 0 Personal Net Worth Statement For DBE/ACDBE Program Eligibility U.S. Department of Transportation OMB APPROVAL NO: £105-0510 EXPIRATION DATE: 8/31/2018 As of This form is used by all participants in the U.S. Department of Transportation's Disadvantaged Business Enterprise (DBE) and Airport Concession DBE (ACDBE) Programs. Each individual owner of a firm applying to participate as a DBE or ACDBE, whose ownership and control are relied upon for DBE certification must complete this form. Each person signing this form authorizes the certifying agency to make inquiries as necessary to verify the accuracy of the statements made. The agency you apply to will use the information provided to determine whether an owner is economically disadvantaged as defined in the DBE program regulations 49 C.F.R. Parts 23 and 26. Return form to appropriate certifying agency, not U.S. DOT. Applicant Name: Residence: (As reported to the IRS) Address, City, State and Zip Code Residence Phone Business Name of Applicant Firm Business Phone Spouse's Full Name: Marital Status: D Single, D Married, D Divorced, D Union ASSETS (Omit Cents) LIABILITIES Cents) (Omit Cash and Cash Equivalents $ Loan on Life Insurance (Complete Section 5) $ Retirement Accounts (IRAs, 401 Ks, 403Bs. Pensions. etc.) (Report full value minus Federal taxes and penalties if applicable if assets were distributed today) (Complete Section 3) $ Mortgages on Real Estate Excluding Primary Residence Debt (Complete Section 4) $ Brokerage, Investment Accounts $ Notes, Obligations on Personal Property (Complete Section 6) $ Assets Held in Trust $ Noles & Accounts Payable to Banks and others (Complete Section 2) $ Loans from You to the Firm, Other Entities, Individuals, & Other Receivables (Complete Section 6) $ Other Liabilities (Complete Section 8) $ Real Estate Excluding Primary Residence (Complete Section 4) $ Unpaid Taxes (Complete Section 8) $ Life Insurance (Cash Surrender Value Only) (Complete Section 5) $ Other Personal Property and Assets (Complete Section 6) $ Business Interests Other Than the Applicant Firm (Complete Section 7) $ Total Assets $ Total Liabilities $ NET WORTH Section 2. Notes Payable to Banks and Others Original Balance Current Balance Payment Amount Frequency (monthly, etc.) How Secured or Endorsed Type of Collateral U.S. DOT Personal Net Worth Statement for DBE/ACDBE Program Eligibility • Page 1003 of 5 VerDate Sep<11>2014 20:42 Aug 10, 2018 Jkt 244001 PO 00000 Frm 00139 Fmt 4703 Sfmt 4725 E:\FR\FM\13AUN1.SGM 13AUN1 EN13AU18.042</GPH> sradovich on DSK3GMQ082PROD with NOTICES Name of Noteholder(s) 40120 Federal Register / Vol. 83, No. 156 / Monday, August 13, 2018 / Notices Section 3. Brokerage and custodial accounts, stocks, bonds, retirement accounts. (Full Value) (Use attachments if necessary). Name of Security I Brokerage Account I Retirement Account Markel Value Quotation/Exchange Cost Dale of Quotation/Exchange Total Value Section 4. Real Estate Owned (Including Primary Residence, Investment Properties, Personal Property Leased or Rented for Business Purposes, Farm Properties, or any Other Income Producing property), (List each parcel separately. Add additional sheets if necessary). Primary Residence Property C Property B Type of Property Address Date Acquired and Method of Acquisition (purchase, inherit, divorce, gift, etc.) Names on Deed Purchase Price Present Market Value Source of Markel Valuation Name of all Mortgage Holders Mortgage Ace. # and balance (as of date of form) Equity line of credit balance Amount of Payment Per Month/Year (Specify) Section 5. Life Insurance Held (Give face amount and cash surrender value of policies, name of insurance company and beneficiaries). Face Value Cash Surrender Amount Beneficiaries Loan on Policy Information U.S. DOT Personal Net Worth Statement for DBE/ACDBE Program Eligibility • Page 1004 of 5 VerDate Sep<11>2014 20:42 Aug 10, 2018 Jkt 244001 PO 00000 Frm 00140 Fmt 4703 Sfmt 4725 E:\FR\FM\13AUN1.SGM 13AUN1 EN13AU18.043</GPH> sradovich on DSK3GMQ082PROD with NOTICES Insurance Company 40121 Federal Register / Vol. 83, No. 156 / Monday, August 13, 2018 / Notices Section 6. Other Personal Property and Assets (Use attachments as necessary) Total Present Value Type of Property or Asset Amount of Liability (Balance) Is this asset insured? Lien or Note amount and Terms of Payment Automooiles and Vehicles (including recreation vehicles, motorcycles, ooats, etc.) Include personally owned vehicles that are leased or rented to ousinesses or other individuals. Household Goods I Jewelry Loans from owner to Firm, Other Entities, Individuals Other (List) Accounts and Notes Receivables Section 7. Value of Other Business Investments, Other Businesses Owned (excluding applicant firm) Sole Proprietorships, General Partners, Joint Ventures Limited Uaoility Companies, Closely-held and Public Traded Corporations Section 8. Other Liabilities and Unpaid Taxes (Describe) Section 9. Transfer of Assets: Have you within 2 years of this personal net worth statement, transferred assets to a spouse, domestic Partner, relative, or entity in which vou have an ownership or beneficial interest includinq a trust? Yes o No o If ves, describe. I declare under penalty of perjury that the information provided in this personal net worth statement and supporting documents is complete, true and correct. I certify that no assets have oeen transferred to any oeneficiary for less than fair market value in the last two years. I recognize that the information submitted in this application is for the purpose of inducing certification approval by a government agency. I understand that a government agency may, by means it deems appropriate, determine the accuracy and truth of the statements in the application and this personal net worth statement, and I authorize such agency to contact any entity named in the application or this personal financial statement. including the names banking institutions, credit agencies, contractors. clients, and other certifying agencies for the purpose of verifying the information supplied and determining the named firm's eligibility. I acknowledge and agree that any misrepresentations in this application or in records pertaining to a contract or subcontract will be grounds for terminating any contract or subcontract which may be awarded; denial or revocation of certification; suspension and debarment; and for initiating action under federal and/or state law concerning false statement, fraud or other applicable offenses. NOTARY CERTIFICATE: (Insert applicable state acknowledgment, affirmation, or oath) Signature (DBE/ACDBE 01tv11er) Date Privacy Act In co!!ecting the information requested by this form, the Department of Transportation complies with Federal Freedom of Information how 15 used The Information used so!e!y to (DBE) Program 49 C.F .R. Parts in '<.,;on~~~'u"ct"c DBE Programs as defined FR 19477). review DOT's Fed era! U.S C. 552 and Ito I ~,- U.S. DOT Personal Net Worth Statement for DBE/ACDBE Program Eligibility • Page 1005 of 5 VerDate Sep<11>2014 20:42 Aug 10, 2018 Jkt 244001 PO 00000 Frm 00141 Fmt 4703 Sfmt 4725 E:\FR\FM\13AUN1.SGM 13AUN1 EN13AU18.044</GPH> sradovich on DSK3GMQ082PROD with NOTICES ~~~~a) 40122 Federal Register / Vol. 83, No. 156 / Monday, August 13, 2018 / Notices General Instructions fot· Completing the Personal Net Worth Statement for DBE/ACDBE Program Eligibility Please do not make adjustments to your figures pursuant to U.S. DOT regulations 49 C.F.R. Parts 23 and 26. The agency that you apply to will use the infom1ation provided on your completed Personal Net Worth (PNW) Statement to detennine whether you meet the economic disadvantage requirements of 49 C.F .R. Parts 23 and 26. If there are discrepancies or questions regarding your form, it may be ret11med to you to correct and complete again. An individual's personal net worth according to 49 C.F.R. Parts 23 and 2o includes only his or her own share of assets held separately, jointly, or as conununity property with the individual's spouse and excludes the following • Individual's ownership interest in the applicant finn; • Individual's equity in his or her primary residence; • Federal Tax and penalties, if applicable, that would accrue if retirement savings or investments (e.g., pension plans, Individual Retirement Accounts, 40l(k) accounts, etc.) were distributed at the present time. Indicate on the form if any items are jointly owned. If the personal net worth of the majority owner(s) of the firm exceeds $1.32 million, as defined by 49 C.F.R. Parts 23 and 26, tl1e firm is not eligible for DEE or ACDEE certification. If the personal net worth of the majority owncr(s) exceeds the $1.32 million cap specified in §26.67(a)(2)(i) at any time after your firm is certified, the firm is no longer eligible for certification. Should iliat occur. it is your responsibility to contact your certifying agency in writing to advise tllat your firm no longer qualifies as a DEE or A CD BE. Yon must fill out all line items on the Personal Net Worth Statement. Brokerage and Custodial Accounts, Stocks, Bonds, Retirement Accounts: Report total value on page 1, and on page 2, section 3, enter the name of the security, brokerage account, retirement account, etc.; the cost; market value of the asset; the date of quotation; and total value as of the date of the PNW statement. Assets Held in Trust: Enter the total value of the assets held in tmst on page 1, and provide the names of beneficiaries and tmstees, and other infonnation in Section o on page 3. Loans fmm you to the firm, other Entities, Individuals, and Other Receivables not listed: Enter current balances of loans you have extended to tllis finn and to other entities or individuals, plus interest payable on those loans; and other receivables not listed above. Complete Section 6 on page 3. Real Estate: The total value of real estate excluding your primary residence should be listed on page I. In section 4 on page 2, please list your primary residence in column I, including the address. meU10d of acquisition, date of acquired, names of deed, purchase price, present fair market value, source of market valuation, names of all mortgage holders. mortgage account number and balance, equity line of credit balance, and amount of payment. List this infonnation for all real estate held. Please ensure that this section contains all real estate owned, including rental properties, vacation properties, connnercial properties. personal property leased or rented for business purposes, farm properties and any oilier income producing properties, etc. Attach additional sheets if needed. If necessary, usc additional sheets of paper to report all information and details. If you have any questions about completing this form, please contact ilie certifying agency. Life Insurance: On page l, enter ilie cash surrender value of this asset. In section 5 on page 2, enter ilic name ofilic insurance company, ilic face value ofilic policy, cash surrender value, names of beneficiaries, and loans on ilic policy. All assets must be reported at ilieir current fair market values as of the date of your statement. Assessor's assessed value for real estate, for example, is not acceptable. Assets held in a trust should be included. Other Personal Pmperty and Assets: Enter the total value of personal property and assets you own on page I. Personal property includes motor vehicles, boats, trailers, jewelry, funliturc, household goods, collectibles, clotlling, and personally owned vehicles tllat are leased or rented to businesses or other individuals. In section 6 on page 3, list these assets and enter the present value, the balance of anv liabilities, whether ilie asset is insured, and lien or note · information and terms of payments. For accounts and notes receivable, enter the total value of alimonies owed to you personally, if any. Yon may also be asked to provide a copy of any liens or notes on ilie property. Retirement Accounts, IRA, 401K~, 403Bs, Pensions: On page l, enter ilie full value minus Federal ta" and penalties that would apply if assets were distributed as of the date of the fom1. Describe the number of shares, name of securities, cost market value, date of quotation, and total value in section 3 on page 2. Other Business Interests Other than Applicant Firm: On page 1, enter ilie total value of your oilier business investments (excluding the applicant firm). In section 7 on page 3, enter information concenling the businesses you U.S. DOT Personal Net Worth Statement for DBE/ACDBE Program Eligibility • Page 1006 of 5 VerDate Sep<11>2014 20:42 Aug 10, 2018 Jkt 244001 PO 00000 Frm 00142 Fmt 4703 Sfmt 4725 E:\FR\FM\13AUN1.SGM 13AUN1 EN13AU18.045</GPH> sradovich on DSK3GMQ082PROD with NOTICES Cash and Cash Equivalents: On page 1, enter the total amount of cash or cash equivalents in bank accounts, including checking, savings, money market, certificates of deposit held domestic or foreign. Provide copies of the bank statement. Federal Register / Vol. 83, No. 156 / Monday, August 13, 2018 / Notices hold an ownership interest in, such as sole proprietorships, partnerships, joint ventures, corporations, or limited liability corporations (other than the applicant finn). Do not reduce the value of these entries by any loans from the outside firm to the DBE/ACDBE applicant business. Liabilities Mortgages on Real Estate: Enter the total balance on all mortgages payable on real estate on page 1. Loans on Life Insurance: Enter the total value of all loans due on life insurance policies on page 1, and complete section 5 on page 2. Notes & Accounts Payable to Bank and Others: On page 1, section 2, enter details concerning any liability, including name of notcholdcrs, original and current balances, payment terms, and security/collateral information. The entries should include automobile installment accounts. This should not, however, include any mortgage balances as this information is captured in section 4. Do not include loans for your business or mortgages for your properties in this section. You may be asked to submit copy of note/security agreement, and the most recent account statement. have co-signed on a relative's loan, but you are not responsible for the debt until your relative defaults, that is a contingent liability. Contingent liabilities do not count toward your net worth until they become actual liabilities. Unpaid Taxes: Enter the total amount of all taxes that are currently due, but are unpaid on page 1, and complete section 8 on page 3. Contingent tax liabilities or anticipated taxes for current year should not be included. Describe in detail the name of the individual obligated, names of cosigners, tlte type of unpaid tax, to whom the tax is payable, due date, amount, and to what property, if any, the tax lien attaches. If none, state "NONE." You must include documentation, such as tax liens, to support the amounts. Transfers of Assets: Transfers of Assets: If you checked the box indicating yes on page 3 in this category, provide details on all asset transfers (within 2 years of the date of tlris personal net worth statement) to a spouse, domestic partner, relative, or entity in which you have an ownership or beneficial interest including a trust. Include a description of the asset; names of individuals on the deed, title, note or otl1er instrument indicating ownership rights; the names of individuals receiving the assets and their relation to the transferor; the date of the transfer; and the value or consideration received. Subnrit documentation requested on tl1e fom1 related to the transfer. Affidavit Be sure to sign and date the statement. The Personal Net Worth Statement must be notarized. U.S. DOT Personal Net Worth Statement for DBE/ ACDBE Program Eligibility • Page 1007 of 5 VerDate Sep<11>2014 20:42 Aug 10, 2018 Jkt 244001 PO 00000 Frm 00143 Fmt 4703 Sfmt 4725 E:\FR\FM\13AUN1.SGM 13AUN1 EN13AU18.046</GPH> sradovich on DSK3GMQ082PROD with NOTICES Other Liabilities: On page I, enter the total value due on all other liabilities not listed in the previous entries. In section 8, page 3, report the name of the individual obligated, names of co-signers, description of the liability, the name of the entity owed, the date of the obligation, payment amounts and tenus. Note: Do not include contingent liabilities in Uris section. Contingent liabilities are liabilities that belong to you only if an event(s) should occur. For example, if you 40123 40124 Federal Register / Vol. 83, No. 156 / Monday, August 13, 2018 / Notices Appendix F UNIFORM CERTIFICATION APPLICATION DISADVANTAGED BUSINESS ENTERPRISE (DBE) I AIRPORT CONCESSION DISADVANTAGED BUSINESS ENTERPRISE (ACDBE) 49 C.F.R. Parts 23 and 26 Roadmap for Applicants 1. Should I apply? You may be eligible to participate in the DEE/ACD BE program if: • The firm is a for-profit business that performs or seeks to perform transportation related work (or a concession activity) for a recipient of Federal Transit Administration, Federal Highway Administration, or Federal Aviation Administration funds. • The finn is at least 51% owned by a socially and economically disadvantaged individual(s) who also controls it. • The firm's disadvantaged owners are U.S. citizens or lawfully admitted permanent residents of the U.S. • The firm meets the Small Business Administration's size standard and docs not exceed $23.9R million in gross annual receipts for DBE ($56.42 million for ACDBEs). (Other size standards apply for ACD BE that arc banks/financial institutions, car rental companies, pay telephone finns, and automobile dealers.) 2. How do I apply? First time applicants for DBE certification must complete and submit this certification application and related material to the certifying agency in your home state and participate in an on-site interview conducted by that agency. The attached document checklist can help you locate the items you need to submit to the agency with your completed application. lfyou fail to submit the required documents, your application may be delayed and/or denied. Firms already certified as a DEE do not have to complete this form, but may be asked by certifying agencies outside of your home state to provide a copy of your initial application form, supporting documents, and any other information you submitted to your home state to obtain certification or to any other state related to your certification. 3. Where can I send my application? [INSERT UCP PARTICIPATING MEJ\1BER CONTACT INFORMATION] 4. Who will contact me about my a1>plication and what are the eligibility standards? A transportation agency in your state that performs certification functions will contact you. The agency is a member of a statewide Unified Certification Program (UCP), which is required by the U.S. Department of Transportation. The UCP is a one-stop certification program that eliminates the need for your finn to obtain certification from multiple certifying agencies within your state. The UCP is responsible for certifying firms and maintaining a database of certified DBEs and ACDBEs, pursuant to the eligibility standards found in 49 C.F.R. Parts 23 and 26. 5. Where can I find more information? U.S. DOT-https://www.transportation.gov/civil-rights (This site provides useful links to the rules and regulations governing the DEE/ACDBE program, questions and answers, and other pertinent information) SEA-Small Business Size Standards matched to the North American Industry Classification System (NAICS): http :1/www. census. gov/eos/www/naics/ and https://www. sba. gov/content/table-small-business-size-standards. Under 49 C.F.R. §26.107, dated Febmary 2, 1999 and January 28, 2011, if at any time, the Department or a recipient has reason to believe that any person or firm has willfully and knowingly provided incorrect information or made false statements, the Department may initiate suspension or debarment proceedings against the person or fim1under 2 C.F.R. Parts 180 and 1200, Konprocurement Suspension and Department, take enforcement action under 49 C.F.R. Part 31, Program Fraud and Civil Remedies, and/or refer the matter to the Department of Justice for criminal prosecution under 18 U.S.C. 1001, which prohibits false statements in Federal programs. U.S. DOT Uniform DBE/ACDBE Certification Application • Page 1008 of 15 VerDate Sep<11>2014 20:42 Aug 10, 2018 Jkt 244001 PO 00000 Frm 00144 Fmt 4703 Sfmt 4725 E:\FR\FM\13AUN1.SGM 13AUN1 EN13AU18.047</GPH> sradovich on DSK3GMQ082PROD with NOTICES In collecting the information requested by this form, the Department of Transportation (Department) complies with the provisions of the Federal Freedom oflnformation and Privacy Acts (5 U.S.C. 552 and 552a). The Privacy Act provides comprehensive protections for your personal information. This includes how information is collected. used, disclosed, stored, and discarded. Your information will not be disclosed to third parties without your consent. 1l1e information collected will be used solely to determine your tim1's eligibility to participate in the Department's Disadvantaged Business Enterprise Program as defined in 49 C.F.R. §26.5 and the Airport Concession Disadvantaged Business Enterprise Program as defined in 49 C.F.R. §23.3. You may review DOT's complete Privacy Act Statement in the Federal Register published on Aprilll, 2000 (65 FR 19477). Federal Register / Vol. 83, No. 156 / Monday, August 13, 2018 / Notices 40125 INSTRUCTIONS FOR COMPLETING THE DISADVANTAGED BUSINESS ENTERPRISE (DBE) AIRPORT CONCESSIONS DISADVANTAGED BUSINESS ENTERPRISE (ACDBE) UNIFORM CERTIFICATION APPLICATION NOTE: All participating firms must be for-profit enterprises. If your firm is not for profit, then you do NOT qualify for the DBE/ACDBE program and should not complete this application. If you require additional space for any question in this application, please attach additional sheets or copies as needed, taking care to indicate on each attached sheet/copy the section and number of this application to which it refers. Section 1: CERTIFICATION INFORMATION A. Basic Contact Information (I) Enter the contact name and title of the person completing this application and the person who will serve as your finn's contact for this application. (2) Enter lhe legal name or your finn, as inclicalecl in your finn's Articles ofincorporation or charter. (3) Enter the primary phone number of your firm. (4) Enter a secondary phone number, if any. (5) Enter your fim1's fax number, if any. (6) Enter the contact person's email address. (7) Enter your linn's website acldresses, if any. (8) Enter the street address of the fnm where its offices are physically located (not a P.O. Box). (9) Enter the mailing address of your firm, if it is different from your fm11' s street address. B. Prior/Other Certifications and Applications (10) Check the appropriate box indicating whether your firm is currently certified in the DBE/ACDBE programs, and provide the name of the certifying agency that certified your finn. List the dates of any site visits conducted by your home state and any other slates or lJCP members. Also provide lhe names or state/UCP members that conducted the review. (II) Indicate whether your firm or any films owned by the persons listed has ever been denied certification as a DBE/ACDBE, 8(a), or Small Disadvantaged Business (SDB) finn, or state and local MBE/WBE finn. lnclicale ir lhe finn has ever been clecerlifiecllrom one of these programs. Indicate if the application was withdrawn or whether the firm was debarred, suspended, or otherwise had its biddi11g privileges denied or restricted by any state or local agency, or Federal entity. If your answer is yes, identity the name of the agency, am! explain fully the nature of the action in the space provided. Indicate if you have ever appealed this decision to the Department and if so, attach a copy ofUSDOT's final agency decision(s). A. Business profile: (I) Give a concise description of the fnm's prinlary activities, the product( s) or services the company provides, or type of construction. If your company otTers more than one product/service, list primmy proclucl or service first (allach additional sheets i r necessary). This description may be used in our UCP online directory if you arc certified as a DBE. B. Relationships and Dealings with Other Businesses ( 1) Check the appropriate box that indicates whether your finn is co-located at any of its busi11ess locations, or whether your finn shares a telephone numher(s), a post otlice box, any otlice space, a yar~ warehouse, other facilities, any equipment, financing, or any otiice staff and/or employees with m1y other busi11ess, organization or entity of any kind. If you answered "Yes," then specify tl1e name of tl1e other finn( s) and fully explain the nature of your relationship witl1 tl1ese other businesses by identirying lhe business or person with whom you have any tormal, intormal, written, or U.S. DOT Uniform DBE/ACDBE Certification Application • Page 1009 of 15 VerDate Sep<11>2014 20:42 Aug 10, 2018 Jkt 244001 PO 00000 Frm 00145 Fmt 4703 Sfmt 4725 E:\FR\FM\13AUN1.SGM 13AUN1 EN13AU18.048</GPH> sradovich on DSK3GMQ082PROD with NOTICES Section 2: GENERAL INFORMATION (2) 1r you know lhe appropriate NAICS Code f(JT lhe line(s) of work you identified in your business profile, enter the codes in the space provided. (3) State the date on which your fmn was established as stated in your finn's Articles of Incorporation or charter. (4) Slate lhe elate each person became a rinn o\Vner. ( 5) Check the appropriate box describing the manner in which you and each other owner acquired ownership of your firm. If you checked "Other," explain in the space provided. ( 6) Check the appropriate box that indicates whether your linn is "for profit." If you checked "No," then you do NOT quality for the DBE/ACDBE program and should not complete this application. All participating finns must be for-profit enterprises. Provide the Federal Tax ID number as stated on your fm11's Federal l<L"X retum. (7) Check the appropriate box that describes the type of legal busi11css stmcturc of your firm, as indicated in your firm's Articles of Incorporation or sinlilar document. If you checked "Other," briet1y explain in the space provided. (8) Indicate in the spaces provided how many employees your !Inn has, specifying the number or employees who work on a full-time, part-time, and seasonal basis. Attach a list of employees. their job titles, m1d dates of employment, to your application. (9) Specify the finn's gross receipts for each of the past tlu·ee years, as stated in your finn's filed Federal tax returns. You must submit complete copies or lhe finn's Federal tax retums for each year. If there are any affiliates or subsidiaries of the applicant firm or owners, you must provide these firms' gross receipts and submit complete copies of tl1ese tlrm(s) Federal tax retums. Affiliation is defined in 49 C.F.R. §26.5 and 13 C.F.R. Part 121. 40126 Federal Register / Vol. 83, No. 156 / Monday, August 13, 2018 / Notices (2) (3) (a) (b) (c) (d) (e) (f) oral agreement. Provide an explanation of any items shared with other finns in the space provided. Check the appropriate box indicating whether any other finn currently has or had an ownership interest in your firm at present or at any time in the past. lf you checked yes, please explain. Check the appropriate box tlmt indicates whether at present or at any time in the past your finn: ever existed under ditTerent mvnership, a ditlerent type of ow1rership, or a different name; existed as a subsidiary of any other firm; existed as a partnership in which one or more of the partners are/were other finns; ow11ed any percentage of any other tinn; and had any subsidiaries of its own. served as a subcontractor with another firm constituting more tlmn 25% of your tum's receipts. If you answered "Yes" to any of the questions in (3)(a-f), you may he asked to explain the arrangement in detail. Section 3: MAJORITY OWNER INFORMATTON Tdentity all individuals or holding companies with any ov.nership interest in your finn, providing tlre infonnation requested below (if your finn has more than one owner, provide completed copies of this section for each ow1rer ): B. Additional Owner Information ( l) Describe tire familial relationship of tlris mv1rer to each other ow1rer of your firm and employees. (2) Indicate whether tlris owner perfonns a management or supervisory function for any other business. If you checked "Yes," state the name of tire other business and this owner's fi.mctionltitlc held in that business. Section 4: CONTROL A (1) (2) (3) (4) Identity the firm's Officers and Board of Directors In the space provided, state the name, title, date of appoinlmenl, elhuicily, ancl gencler of each officer. In the space provided, state the name, title, date of appointment, etlmicity, and gender of each individual serving on your finn's Doard of Directors. Check the appropriate box lo inclicale whether any of your firm's ofticers and/or directors listed above per1onns a managemenl or supervisory runclion ror any other business. If you answered "Yes," identifv each person by name, Iris/her title, tire name of tire other business in which s/he is involved, and his/her funclion perfonnecl in thal other business. Check the appropriate box that indicates whether any of your finn's otlicers and/or directors listed above own or work for any other finn(s) that has a relationship witlr your finn. (e.g., ownership interest, shared office space, financial investments, equipment leases, personnel sharing, elc.) If you answerecl "Yes," identify the name of the firm, tire individual's name, and the nature of his/her business relationslrip with that other firm. B. Duties of Owners, Officers, Directors, Managers and Key Personnel (1 ), (2) Specify the roles of the majority and minority owners, directors, otlicers, and managers, and key U.S. DOT Uniform DEE/ACDEE Certification Application • Page 1010 of 15 VerDate Sep<11>2014 20:42 Aug 10, 2018 Jkt 244001 PO 00000 Frm 00146 Fmt 4703 Sfmt 4725 E:\FR\FM\13AUN1.SGM 13AUN1 EN13AU18.049</GPH> sradovich on DSK3GMQ082PROD with NOTICES A. Identify the majority owner of the firm holding 51% or more ownership interest ( l) Enter the full name of the owner. (2) Enter his/her title or position within your finn. (3) Give his/her home phone number. (4) Enter his/her home (street) address. (5) Indicate this owner's gender. (6) Iclenlify the owner's elhnic group membership. If you checked "Other," specify this owner's ethnic group/identity not otherwise listed. (7) Check the appropriate box to indicate whether this ow1rer is a U.S. citizen or a lawfully admitted permanent resident. If this owner is neither a U.S. cilizen nor a lawfully aclmillecl pennanenl resiclenl of the U.S., then this owner is NOT eligible for cerli1icalion as a DEE owner. (8) Enter the number of years during which this owner has been an owner of your fmn. (9) Indicate the percentage of the total ownership this person holcls ancl the clale acquirecl, inclucling (if appropriate), the class of stock owned. (10) Indicate the dollar value of tlris owner's initial investment to acquire an ownership interest in your finn, broken down by cash, real estate, equipment, and/or other investment. Describe how you acquired your business ancl allach clocumenlalion subslanlialing this investment. (3) (a) Check the appropriate box tlrat indicates whether this owner owns or works for any other firm( s) that has l!!.!Y relationship witlr your finn. lf you checked "Yes," identify the name of the other business, the nature of tire business relationslrip, and tire owner's function at the finn. (b) lf the owner works for any other finn, non-profit organization, or is engaged in any other activity more tlran l 0 hours per week, please identity tlris activity. (4) (a) Provide the personal net worth of the owner applying for certification in tire space provided. Complete and attach the accompanying "Personal Net Worth Statement for DEE/ACDEE Program Eligibility" with your application. Note, complete this section and accompanying statement only for each owner applying for DEE qualification (i.e., for each owner clainring to be socially and economically disadvantaged). (b) Check tire appropriate box that indicates whetlrer any trust has heen created for the benefit of the disadvantaged owner(s). If you answered "Yes," you may be asked to provide a copy of the trust instrument. (5) Check the appropriate to indicate whether any of your immediate family members, managers, or employees, own, manage, or are associated with another company. Immediate family member is defined in 49 C.F.R. §26.5. If you answered "Yes," provide the name of each person, your relationship to tlrem, the name of the company, the type of business, and whether they own or manage tire company. Federal Register / Vol. 83, No. 156 / Monday, August 13, 2018 / Notices persmmel who are responsible for the functions listed for the finn. Submit resumes for each owner aud non-owner identified belov.. Slate lhe mune of lhe individmtl, lille, race and gender and pencentage ov.11ership if any. Circle the frequency of each person's involvement as follows: "always, frequently, seldom, or never" in each area. Indicate whether any of the persons listed in this section perfonn a management or supervisory function for any other business. Identify the person, business, aud their title/function Identify if any of the persons listed above own or work for any otlrer finn(s) tlmt has a relationship with this finn (e.g. ownership interest, shared office space, financial investment, equipment, leases, personnel sharing. etc.) If you answered ·'Yes," describe the natme of his/her business relationship with that otlrer finn. C. Inventory: Indicate finn inventory in these categories: (1) Equipment and Vehicles State the make and model, and current dollar value of each piece of equipment and motor vehicle held and/or used hy your tlnn. Indicate whether each piece is either ov.ned or leased by your tlnn or ov.ner, whetlrer it is used as collateral, and where this item is stored. (2) Office Space State tire street address of each office space held and/or used by your firm. Indicate whether your firm or mvner owns or leases the office space and the current dollar value of that property or its lease. (3) Storage Space State the str·eet adch·ess of each storage space held and/or used by your finn. Indicate whether your fmn or ov.ner owns or leases the storage space and the current dollar value of llial properly or ils lease. Provide a signed lease agreement for each property. D. Does your firm rely on any other firm for management functions or employee payroll'! Check the appropriate box that indicates whether your fum relics on auy other tirm for management fimctions or for employee payroll. If you answered "Yes," you may be asked to explain the narure of that reliance and the extent to which the other tlnn carries out such functions. E. Financial/ Banking Information State the name, City and State of your firm's bank. Identify llie persons able lo sign checks on lliis account. Provide hank authorization and signature cards. Bonding Information. State your finn's bonding linlits both aggregate and projecllimils. each loau was made to your finn. Provide copies of signed loan agreements and security agreements G. Contributions or transfers of assets to/from your firm and to/from any of its owners or another individual over the past two years: Indicate in the spaces provided, the type of contribution or asset that was transferred, its current dollar value, the person or firm from whom it was transferred, the person or finn to whom it was tmnsfenec"'" the relationship between tire two persons and/or finns, and tire date of tire transfer. H Current licenses/permits held by any owner or employee of your firm. List the name of each person in your firm who holds a professional license or penni!, the type of permit or license, the expiration date of the permit or license, and issuing State of the license or pennit. Attach copies of licenses, license renewal forms, pennits, and haul authority forms. l Largest contracts completed by your firm in the past three years, if any. List llie name of each owner or contractor for each contract, tire name and location of tire projects wrder each contract, the type of work perfonned on each contract, and the dollar value of each contract. J. Largest active _jobs on which your firm is currently working. For each active job listed, state the name of the prime contractor and tire project nurnber, tire location, the type of work perfonned, the project start date, the anticipated completion date, mrd the dollar value ofthe contract. Section 5: AIRPORT CONCESSION (A CD BE) APPLICANTS Cornplele llie entries in lliis sec lion if you are applying for ACDRR certification. Indicate in Section A if you operate a concession at the airport, aud/or supply a good or service to an airport concessionaire. Indicate in Section B whether the applicant finn owns or operates any off.ai:tpori locations, providi:trg tire type of busi:tress, lease i:trfonnation, address/location, mrd mrnual gross receipts generated. Provide similar information in section C for any airport concession locations the finn cunently owns or operates. If tire applicmrt tlnn has mry affiliates, provide the requested infonnation in Section D. Indicate whetlrer the ACDBE linn is participating i:tr tmy joint venlttres, tmd if so, include the original and any amended joint venture agreements. AFFIDAVIT & SIGNATURE The Affidavit of Certification must accompany your application. Carefully read the attached affidavit in its entirety. Fill in the required infomration tor each blmlk space, and sign and date the affidavit i:tt tire presence of a Notary Public, who must tlren notarize tire fonn. State the name aud address of each source, the name of person securing the loan, original dollar amount aud the cunent balance of each loan, and tire pwpose for which U.S. DOT Unifonn DBE/A CDBE Certification Application • Page 1011 of 15 VerDate Sep<11>2014 20:42 Aug 10, 2018 Jkt 244001 PO 00000 Frm 00147 Fmt 4703 Sfmt 4725 E:\FR\FM\13AUN1.SGM 13AUN1 EN13AU18.050</GPH> sradovich on DSK3GMQ082PROD with NOTICES F. Sources, amounts, and purposes of money loaned to your firm, including the names of persons or firms guaranteeing the loan. 40127 40128 Federal Register / Vol. 83, No. 156 / Monday, August 13, 2018 / Notices Section 1: CERTIFICATION INFORMATION I am applying for certification as 0 DBE DACDBE A. Basic Contact Information (1) Contact person and Title: _ _ _ _ _ _ _ __ (2) Legal name offirm: _ _ _ _ _ _ _ _ _ __ (3) Phone#: (_) _ _ - _ _ _ (4) Other Phone#: ( _ ) _ _ - _ _ (5) Fax#: ( _ ) _ _ - _ _ (6) E-mail: _ _ _ _ _ _ _ _ _ _ _ _ _ _ (7) Firm Websites: _ _ _ _ _ _ _ _ _ _ _ _ __ (8) Street address of firm City: (9) Mailing address of firm (ifdifferenl) County/Parish: State: Zip: City: (No P.O. Box): County/Parish: State: Zip: B. Prior/Other Certifications and Applications (10) Is your firm currently certified for any ofthe following U.S. DOT programs? D DBE D A CD BE Names of certifying agencies: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ List the dates of any site visits conducted by your home state and any other states or UCP members: Date _ _ _ Statc/UCP Member: _ _ _ _ _ Date _ _ _ Statc/UCP Member: _ _ _ _ _ __ (11) Indicate whether the firm or any persons listed in this application have ever been: (a) Denied certification or decertified as a DBE, A CD BE, 8(a), SDB, MBE/WBE firm? D Y cs DNo (b) Withdrawn an application for these programs, or debarred or suspended or otherwise had bidding privileges denied or restricted by any state or local agency, or Federal entity? D Yes D No If yes, explain the nature of the action. (l{}'OU appealed the decision to DOT or another agency, attach a copy of the decision) Section 2: GENERAL INFORMATION A. Business Profile: (1) Give a concise description of the tlm1' s primary activities and the product(s) or service(s) it provides. If your company offers more than one product/service, list the primary product or service first. Please use additional paper if necessary. This description may be used in our database and the UCP online directory if you are certified as a DBE or ACDBE. (2) Applicable NAICS Codes for this line of work include:______ I I I (4) J/We have owned this firm since: __/__/__ U.S. DOT UniformDBE/ACDBE Certification Application• Page 1012 of 15 VerDate Sep<11>2014 20:42 Aug 10, 2018 Jkt 244001 PO 00000 Frm 00148 Fmt 4703 Sfmt 4725 E:\FR\FM\13AUN1.SGM 13AUN1 EN13AU18.051</GPH> sradovich on DSK3GMQ082PROD with NOTICES (3) This firm was established on _ __ Federal Register / Vol. 83, No. 156 / Monday, August 13, 2018 / Notices 40129 (5) Method of acquisition (Check all that appZv): D Started new business D Bought existing business D Inherited business D Gifted D Merger or consolidation D Other (explain! _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ (6) Is your firm "for profit"? DYes DNo----> Federal Ta" ID# _ _ _ _ _ _ _ _ _ __ (7) D D D ®STOP! If your finn is NOT for-profit, then you do NOT qualify for tlris program and should not fill out tlris application. Type of Legal Business Structure: (check all that apply): Sole Proprietorship D Limited Liability Partnership Partnership DCorporation Limited Liability Company D Other, Describe _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ (8) Number of employees: Full-time Part-time Seasonal Tot..1.l _ _ __ (Provide a list of employees, their job titles, and dates of employment, to your application). (9) Specify the firm's gross receipts for the last 3 years. (Sub mil complete copies ofthejirm 's Federal fax returnsfor each year. If /here are affiliates or subsidiaries of the applicanl firm or owners, you must submit complete copies of these firms' Federal tax returns). Year _ _ _ Gross Receipts of Applicant Firm $ _ _ _ _ _ _ Gross Receipts of Affiliate Firms $_ _ _ __ Year Gross Receipts of Applicant Firm $ Gross Receipts of Affiliate Firms $_ _ __ Gross Receipts of Affiliate Firms $_ _ _ __ Y car Gross Receipts of Applicant Firm $ B. Relationships and Dealings with Other Businesses (1) Is your firm co-located at any of its business locations, or does it share a telephone number, P.O. Box, office or storage space, yard, warehouse, facilities, equipment, inventory, financing, office staff, and/or employees with any other business, organization, or entity? 0 Y cs 0 No If Yes, explain the nature ofyour relationship with these other businesses by identifYing the business or person with whom you have any formal, informal, written, or oral agreement. Also detail the items shared (2) Has any other firm had an ownership interest in your firm at present or at any time in the past? DYes D No lfYes, explain_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ ({(you answered "Yes" to any of the questions in (2) and/or (3)(a)-(f}, you may be asked to provide further details and explain whether the arrangement continues). U.S. DOT U1riform DBE/ACD BE Certification Application • Page 1013 of 15 VerDate Sep<11>2014 20:42 Aug 10, 2018 Jkt 244001 PO 00000 Frm 00149 Fmt 4703 Sfmt 4725 E:\FR\FM\13AUN1.SGM 13AUN1 EN13AU18.052</GPH> sradovich on DSK3GMQ082PROD with NOTICES (3) At present, or at any time in the past, has your firm: (a) Ever existed under different ownership, a different type of ownership, or a different name? 0 Yes 0 No (b) Existed as a subsidiary of any other firm? 0 Yes 0 No (c) Existed as a partnership in \vhich one or more of the partners are/were other finns? 0 Yes 0 No (d) Owned any percentage of any other finn? 0 Yes 0 No (e) Had any subsidiaries? DYes D No (t) Served as a subcontractor with another finn constituting more than 25% of your finn's receipts? DYes D No 40130 Federal Register / Vol. 83, No. 156 / Monday, August 13, 2018 / Notices Section 3: MAJORITY OWNER INFORMATION A. Identify the majority owner of the firm holding 51% or more ownership interest. (1) Full Name: I (2) Title: City: (4) Home Address (Street and Number): (5) Gender: 0 Male 0 Female (6) Ethnic group membership (Check all that appZr): 0 0 0 0 (7) I (3) Home Phone #: ( )---------Zip: State: (8) Number of years as owner: _ __ (9) Percentage owned: _____ % Class of stock owned: _ _ __ Date acquired _ _ _ _ _ _ __ (10) Initial investment to Black 0 Hispanic Asian Pacific 0 Native American Subcontinent Asian Other (specifY) - - - - - - - - - Type Dollar Value $ Cash Real Estate $ Equipment $ $ Other Describe how you acquired your business: 0 Started business myself 0 It was a gift from: _ _ _ _ _ _ _ _ _ _ _ __ 0 1 bought it from: _ _ _ _ _ _ _ _ _ _ _ __ 0 1 inherited it from: - - - - - - - - - - - - 0 Other - - - - - - - - - - - - - - - - - - acquire ownership interest in firm: U.S. Citizenship: 0 U.S. Citizen 0 Lawfully Admitted Permanent Resident (Attach documentation substantiating your investment) B. Additional Owner Information (1) Describe familial relationship to other owners and employees: (2) Does this owner perform a management or supervisory function for any other business? 0 Yes 0 No If Yes, identifY: Name of Business _ _ _ _ _ _ _ _ _ _ _ _ _ Function!Iitle: _ _ _ _ _ _ _ _ _ _ __ (3)(a) Does this owner own or work for any other firm(s) that has a relationship with this firm? (e.g., 0 Yes 0 No IdentifY the name of the business, and the nature of the relationship, and the owner's function at the firm: ownership inleresl, shared office space, financial inves/menls, equipmenl, leases, personnel shan·ng, e/c.) (b) Does this owner work for any other firm, non-profit organization, or engage in any other activity more than 10 hours per week? 1fyes, identifY this activity: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ (4)(a) What is the personal net worth of this disadvantaged owner applying for certification?$._ _ _ __ (b )Has any trust been created for the benefit of this disadvantaged owner(s)? 0 Yes 0 No (I,[ Yes, you may be asked fo provide a copy of the trust instrument). U.S. DOT UniformDBE/ACDBE Certification Application • Page 1014 of 15 VerDate Sep<11>2014 20:42 Aug 10, 2018 Jkt 244001 PO 00000 Frm 00150 Fmt 4703 Sfmt 4725 E:\FR\FM\13AUN1.SGM 13AUN1 EN13AU18.053</GPH> sradovich on DSK3GMQ082PROD with NOTICES (5) Do any of your immediate family members, managers, or employees own, manage, or are associated with another company? 0 Y cs 0 No IfY cs, provide their name, relationship, company, type of business, and indicate whether they own or manage the company: (Please attach exira sheets, if needed): _ _ _ _ _ _ _ _ __ Federal Register / Vol. 83, No. 156 / Monday, August 13, 2018 / Notices 40131 Section 3: OWNER INFORMATION, Cont'd. A. Identify all individuals, firms, or holding companies that hold LESS THAN 51% ownership interest in the firm (Attach separate sheets for each additional owner) (1) Full Name: (3) Home Phone#: I (2) Title: I City: (4) Home Address (Street and Number): (5) Gender: 0 Male 0 Female (6) Ethnic group membership (Check all that app~v) 0 Hispanic 0 Asian Pacific 0 Native American 0 Subcontinent Asian 0 Other (specifY) - - - - - - - - - ( ) ---------State: Zip: (8) Number of years as owner: _ __ (9) Percentage owned: % Class of stock owned: _ _ __ Date acquired _ _ _ _ _ __ 0 Black (7) (10) Initial investment to acquire ownership interest in firm: U.S. Citizenship: 0 U.S. Citizen 0 Lawfully Admitted Permanent Resident Type Cash Real Estate Equipment Other Dollar Value $ $ $ $ Describe how you acquired your business: 0 Started business myself. 0 It \vas a gift from: _ _ _ _ _ _ _ _ _ _ _ __ 0 I bought it from: _ _ _ _ _ _ _ _ _ _ _ __ 0 I inherited it from: - - - - - - - - - - - - 0 Other - - - - - - - - - - - - - - - - - - ~4ttach documentation substantiating your investment) B. Additional Owner Information (1) Describe familial relationship to other owners and employees: (2) Does this owner perform a management or supervisory function for any other business? 0 Yes 0 No If Yes, identifY: Name of Business: _ _ _ _ _ _ _ _ _ _ _ _ _ Funclion/TiUe: _ _ _ _ _ _ _ _ _ _ __ (3)(a) Does this owner own or work for any other firm(s) that has a relationship with this firm? (e.g., awnerslnj> interest, shared office space .financial investments, equipment, leases, personnel sharing, etc.) 0 Yes 0 No IdentifY the name of the business, and the nature of the relationship, and the owner's function at the firm: (b) Does this owner work for any other firm, non-profit organization, or is engaged in any other activity more than 10 hours per week? If yes, identify this activity: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ (4)(a) What is the personal net worth of this disadvantaged owner applying for certification?$_ _ _ __ (b) Has any trust been created for the benefit of this disadvantaged owner(s)? 0 Yes 0 No (If Yes, you may be asked to provide a copy of the trust instrument). U.S. DOT Uniform DEE/A CD BE Certification Application• Page 1015 of 15 VerDate Sep<11>2014 20:42 Aug 10, 2018 Jkt 244001 PO 00000 Frm 00151 Fmt 4703 Sfmt 4725 E:\FR\FM\13AUN1.SGM 13AUN1 EN13AU18.054</GPH> sradovich on DSK3GMQ082PROD with NOTICES (5) Do any of your immediate family members, managers, or employees own, manage, or are associated with another company? 0 Yes 0 No IfYes, provide their name, relationship, company, type of business, and indicate whether they own or manage: (Please attach extra sheets, if needed): _ _ _ _ _ _ __ 40132 Federal Register / Vol. 83, No. 156 / Monday, August 13, 2018 / Notices Section 4: CONTROL A. Identify your firm's Officers and Board of Directors (If additional space is required, attach a separate sheet): Name (1) Officers of the Company (2) Board of Directors Title Date Appointed Ethnicitv Gender (a) (b) (c) (d) (a) (b) (c) (d) (3) Do any of the persons listed above perform a management or supervisory function for any other business? D Yes D No lfYes, identity for each: Person: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Title: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ Business: Function: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ Person: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ T i t l e : , - - - - - - - - - - - - - - - - - - - - - - Business: Function: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ (4) Do any ofthe persons listed in section A above own or work for any other firm(s) that has a relationship with this firm? (e.g., ownership interest, shared office space, .financial investments, equipment, leases, personnel sharing, etc.) D Yes D No lf Yes, identity for each: FirmName: _ _ _ _ _ _ _ _ _ _ _ _ _ _ Person: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ Nature of Business R e l a t i o n s h i p : - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - B. Duties of Owners, Officers, Directors, Managers, and Key Personnel 1. Complete for all Owners who are responsible for the following functions of the firm (Atrach separate sheets as needed) A= Always F = Frequently S =Seldom N =Never A A A A F F F F A F A F A A A F F F A F A A F F Minority Owner (49% or less) Name: Title: Percent Owned: A F N s s s s s s s N N N N A A A A N A N A s s s s s s N N N A A A N A N N A A F F F s s s s s s N N N N F F F F F F s s s s s s N N N F F F N N N N N U.S. DOT Uniform DEE/ACD BE Certification Application • Page 1016 of 15 VerDate Sep<11>2014 20:42 Aug 10, 2018 Jkt 244001 PO 00000 Frm 00152 Fmt 4703 Sfmt 4725 E:\FR\FM\13AUN1.SGM 13AUN1 EN13AU18.055</GPH> sradovich on DSK3GMQ082PROD with NOTICES Sets policy for company direction/scope of operations Bidding and estimating Major purchasing decisions Marketing and sales Supervises field operations Attend bid opening and lettings Perform office management (billing, accounts receivable/payable, etc ) Hires and fires management staff Hire and fire field staff or crew Designates profits spending or investment Obligates business by contract/credit Purchase equipment Signs business checks Majority Owner (51% or more) Name: Title: Percent Owned: A F N s Federal Register / Vol. 83, No. 156 / Monday, August 13, 2018 / Notices 2. Complete for all Officers, Directors, Managers, and Key Personnel who functions of the firm (Artach separate sheets as needed) Officer/Director/Manager/Key Pers01mel Name: A= Always S =Seldom Title: N =Never F = Frequently Race and Gender: Percent Owned: Sets policy for company direction/scope A F N s of operations F N Bidding and cstimating A s F N Maior purchasing decisions A s Marketing and sales A F N s F N Supervises field opemtions A s Attend bid opening and lcttings A F s N F N Perform office management (billing, A s accounts receivable/pavable, etc.) Hires and fires management staff A F N s Hire and fire field staff or crew A F N s Designates profits spending or investment A F N s Obligates business bv contmct/crcdit A F N s F N Purchase equipment A s Signs business checks A F N s 40133 are responsible for the following Officer/Director/Manager/ Key Pers01mel Name: Title: Race and Gender: Percent Owned: A F N s A A A A A A F F F F F F s s s s s s N N N N N N A A A A A A F F F F F F s s s s s s N N N N N N Do any of the persons listed in B 1 or B2 perform a management or supervisory function for any other business? TfY cs, identifY the person, the business, and their title/function: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ Do any of the persons listed above own or work for any other firm(s) that has a relationship with this firm? (e.g, ownership inleres/, shared office space, financial inves/menls, equipment, leases, personnel sharing, etc.) If Yes, describe tl1e nature of the business relationship: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ C. Inventory: Indicate your firm's inventory in the following categories (Please artach additional sheets if needed): 1. Equipment and Vehicles Make and Model Current Value Owned or Leased by Firm or Owner? Used as collateral? Where is item stored? l. 2. 3. 4. 5. 6. 7. 8. 9. Owned or Leased by Firm or Owner? Current Value of Property or Lease U.S. DOT Uniform DBE/ACDBE Certification Application • Page 1017 of 15 VerDate Sep<11>2014 20:42 Aug 10, 2018 Jkt 244001 PO 00000 Frm 00153 Fmt 4703 Sfmt 4725 E:\FR\FM\13AUN1.SGM 13AUN1 EN13AU18.056</GPH> sradovich on DSK3GMQ082PROD with NOTICES 2. Office Space Street Address 40134 Federal Register / Vol. 83, No. 156 / Monday, August 13, 2018 / Notices 3. Storage Space !Provide signed lease agreements for the properties listed) Street Address Owned or Leased by Firm or Owner? Current Value of Property or Lease D. Does your firm rely on any other firm for management functions or employee payroll? D Yes D No E. Financial/Banking Information (Provide bank authorization and signature cards) Name of bank: City and State: _ _ _ _ _ _ _ _ _ _ _ _ __ The following individuals are able to sign checks on this account: ___________________ Name of bank: City and State: _ _ _ _ _ _ _ _ _ _ _ _ _ __ The following individuals are able to sign checks on this account: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ Bonding Information: If you have bonding capacity, identify the firm's bonding aggregate and project limits: Aggregate limit $ Project limit $ _ _ _ _ _ _ _ __ F. Identify all sources, amounts, and purposes of money loaned to your firm including from financial institutions. Identify whether you the owner and any other person or firm loaned money to the applicant DBE/ACDBE. Include the names of any persons or firms guaranteeing the loan, if other than the listed owner. (l'rovide copies ofsigned loan agreements and security agreements). N arne of Source Address of Source N arne of Person Guaranteeing the Loan Original Amount Current Balance Purpose of Loan !. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ 2. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ____ 3. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ G. List all contributions or transfers of assets to/from your firm and to/from any of its owners or another individual over the past two years (Ailach additional sheets if needed): Contribution/Asset Dollar Value From Whom To Whom Relationship Date of Transferred Transferred Transfer l. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ____ 2. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ____ 3. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ____ H. List current licenses/permits held by any owner and/or employee of your firm (e.g. contractor, engineer, architect, etc.)(Attach additional sheets if needed): Name of License/Permit Holder Type of License/Permit Expiration Date State l. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ 2. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ U.S. DOT UniformDBE/ACDBE Certification Application • Page 1018 of 15 VerDate Sep<11>2014 20:42 Aug 10, 2018 Jkt 244001 PO 00000 Frm 00154 Fmt 4703 Sfmt 4725 E:\FR\FM\13AUN1.SGM 13AUN1 EN13AU18.057</GPH> sradovich on DSK3GMQ082PROD with NOTICES 3. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ____ 40135 Federal Register / Vol. 83, No. 156 / Monday, August 13, 2018 / Notices I. List the three largest contracts completed by your firm in the past three years, if any: Name of Owner/Contractor Name/Location of Project Type of Work Performed Dollar Value of Contract 1.-------------------------------------------------------------------------------2·------------------------------------------------------------------------------- 3·------------------------------------------------------------------------------- J. List the three largest active jobs on which your firm is currently working: Name of Prime Contractor and Project Number Location of Project Type of Work Project Start Date Anticipated Completion Date Dollar Value of Contract 1.-------------------------------------------------------------------------------- 2·-------------------------------------------------------------------------------- 3·-------------------------------------------------------------------------------- U.S. DOT Uniform DBE/A CD BE Certification Application • Page 1019 of 15 VerDate Sep<11>2014 20:42 Aug 10, 2018 Jkt 244001 PO 00000 Frm 00155 Fmt 4703 Sfmt 4725 E:\FR\FM\13AUN1.SGM 13AUN1 EN13AU18.058</GPH> sradovich on DSK3GMQ082PROD with NOTICES Additional Information: 40136 Federal Register / Vol. 83, No. 156 / Monday, August 13, 2018 / Notices SECTION 5- AIRPORT CONCESSION (A CD BE APPLICANTS ONLY) A. I am applying for A CD BE certification to: (check all that apply) D Operate a concession at an airport D Supply a good or service to an airport concessionaire B. Does the applicant firm own/operate any off-airport locations? DYes D No If"Yes, identify thefollowing Address I Location Type of Business Lease Lease (e.g., F&B, News & Gift Retail, Duty Term Start Date Free, Advertising. etc.) (years) c. Does the applicant firm currently own/operate any airport concession locations? DYes D No !{Yes, supply the following information. Airport Name Concession Type Number of Number of (e.g., F &B, News & Leases Locations Gift, Retail, Duty Free, Advertising, etc.) D. Does the applicant firm have any affiliates? DYes D No any locations owned1operated by affiliate firms. Airport Name Annual Gross Receipts Generated Lease Type (e.g. Direct Lease, Subcontract Afanagement Agreement, etc. enter all that apply to the leases listed) !{Yes, provide the following information concerning Concession Type Number of Number of (e.g., F &B, News & Leases Locations Gift, Retail, Duty Free, Advertising, elc.) Annual Gross Receipts Generated E. Is the ACDBE applicant firm a participant in any joint ventures? DYes D No any amended Joint Venture Agreements and any amendments to the agreements. Lease Type (e.g. Direct Lease, Subcontract A1anagement Agreement, etc. enter all that app~v to the leases listed) !{Yes, attach all original and U.S. DOT Uniform DBE/ACD BE Certification Application • Page 1020 of 15 VerDate Sep<11>2014 20:42 Aug 10, 2018 Jkt 244001 PO 00000 Frm 00156 Fmt 4703 Sfmt 4725 E:\FR\FM\13AUN1.SGM 13AUN1 EN13AU18.059</GPH> sradovich on DSK3GMQ082PROD with NOTICES Annual Gross Receipts Generated Federal Register / Vol. 83, No. 156 / Monday, August 13, 2018 / Notices 40137 AFFIDAVIT OF CERTIFICATION 1his form must be signed and notarized for each owner upon which disadvantaged status is relied. A MATERIAL OR FALSE STATEMENT OR OMISSION MADE IN CONNECTION WITH THIS APPLICATION IS SUFFICIENT CAUSE FOR DENIAL OF CERTIFICATION, REVOCATION OF A PRIOR APPROVAL, INITIATION OF SUSPENSION OR DEBARMENT PROCEEDINGS, AND MAY SUBJECT THE PERSON AND/OR ENTITY MAKING THE FALSE STATEMENT TO ANY AND ALL CIVIL AND CRIMINAL PENALTIES AVAILABLE PURSUANT TO APPLICABLE FEDERAL AND STATE LAW. _ _ _ _ _ _ _ _ _ _ _ _ _ _ (full name printed), swear or affinn under penalty of law that Jam _ _ _ _ _ _ _ _ _ _ _ _ (title) of the applicant firm _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ and that 1 have read and understood all of the questions in this application and that all of the foregoing infonnation and statements submitted in this application and its attachments and supporting documents are true and correct to U1e best of my knowledge, and Uml all responses to U1e questions are full and complete, omitting no material information. The responses include all material information necessary to fully and accurately identify and explain the operations, capabilities and pertinent history of the named firm as well as the ownership, control, and affiliations thereof J recognize that the infonnation submitted in this application is for the purpose of inducing certification approval by a government agency. 1 understand tlmt a government agency may, by means it deems appropriate, determine the accuracy and truth of the statements in the application, and I authorize such agency to contact any entity named in the application, and the named firm's bonding companies, banking institutions, credit agencies, contractors, clients, and oU1er certifying agencies for the purpose of verifying tl1e information supplied and detennining tl1e named finn's eligibility. I agree to submit to govemment audit, examination and review of books, records, documents and files, in wlmtever form they exist, of the named firm and its affiliates. inspection of its places(s) of business and equipment, and to permit interviews of its principals, agents. and employees. J understand that refusal to permit such inquiries slmll be grounds for denial of certification. If awarded a contract, subcontract, concession lease or sublease, I agree to prompUy and direcUy provide U1e prime contractor, if any, and U1e Department, recipient agency, or federal funding agency on an ongoing basis, current, complete and accurate information regarding (1) work performed on tl1e project; (2) payments; and (3) proposed changes, if any, to the foregoing arrangements. I certify that I am a socially and economically disadvantaged individual who is an owner of tl1e above-referenced firm seeking certification as a Disadvantaged Business Enterprise or Airport Concession Disadvantaged Business Enterprise. In support of my application, I certify tlmt I am a member of one or more of the following groups, and tlmt I lmve held myself out as a member of the group(s): (Check all tlmt apply): 0 Female 0 Black American 0 Hispanic American 0 Native American 0 Asian-Pacific American 0 Subcontinent Asian American 0 Other (specify) I certify that I am socially disadvantaged because I have been subjected to racial or eUnric prejudice or cultural bias, or have suffered the effects of discrimination, because of my identity as a member of one or more of tl1e groups identified above, without regard to my individual qualities. I further certify tlmt my personal net worth does not exceed $1.32 million, and tlmt I am economically disadvantaged because my ability to compete in the free enterprise system lms been impaired due to diminished capital and credit opportunities as compared to others in the same or similar line of business who are not socially and economically disadvantaged. I declare under penally of peij ury Uml U1e infonnation provided in tlris application and supporting documents is true and correct. Signature----.,---------(DBE/ACDBE Applicant) (Date) NOTARY CERTIFICATE U.S. DOT Uniform DEE/A CD BE Certification Application • Page 1021 of 15 VerDate Sep<11>2014 20:42 Aug 10, 2018 Jkt 244001 PO 00000 Frm 00157 Fmt 4703 Sfmt 4725 E:\FR\FM\13AUN1.SGM 13AUN1 EN13AU18.060</GPH> sradovich on DSK3GMQ082PROD with NOTICES I agree to provide written notice to the recipient agency or Unified Certification Program of any 111aterial clmnge in the infommtion contained in the original application within 30 calendar days of such change (e.g., ownership changes, address/telephone number, personal net worth exceeding $1.32 million, etc.). J acknowledge and agree that any misrepresentations in this application or in records pertaining to a contract or subcontract will be grounds for terminating any contract or subcontract which 111ay be awarded; denial or revocation of certification; suspension and debarment; and for initiating action under federal and/or state law conccming false statement, fraud or other applicable offenses. 40138 Federal Register / Vol. 83, No. 156 / Monday, August 13, 2018 / Notices UNIFORM CERTIFICATION APPLICATION SUPPORTING DOCUMENTS CHECKLIST In order to complete your application for DBE or A CD BE certification, you must attach copies of all of the following REQUIRED documents. A failure to supply any information requested by the UCP may result in your firm denied DBE/ACDBE certification. = Required Documents (or All Applicants l Resumes (that include places of employment with corresponding dates), for all owners, officers, and key personnel of the applicant firm J Personal Net Worth Statement for each socially and economically disadvantaged owners who the applicant firm relics upon to satisfy the Regulation's 51% ownership requirement. J Personal Federal tax returns for the past3 years, if applicable, for each disadvantaged owner J Federal tax returns (and requests for extensions) filed by the finn and its affiliates with related schedules, for the past 3 years. J Documented proof of contributions used to acquire ownership for each owner (e.g., both sides ofcancelled checks) l Signed loan and security agreements, and bonding forms L List of equipment and/or vehicles owned and leased including YIN numbers, copy of titles, proof of ownership, insurance cards for each vehicle. J Titlc(s), registration certificatc(s), and U.S. DOT numbers for each truck owned or operated by your finn J Licenses, license renewal fonns, pennils, and haul authority forms J Descriptions of all real estate (including office/storage space, etc.) owned/leased by your finn and documented proof of ownership/signed leases J Documented proof of any transfers of assets to/from your firm and/or to/from any of its owners over the past 2 years J DBE/ACDBE and SEA 8(a). SDB, MBE/WBE certifications, denials, and/or decertifications, if applicable; and any U.S. DOT appeal decisions on these actions. J Bank authorization and signatory cards J Schedule of salaries (or other remuneration) paid to all officers, managers, owners, and/or directors of the finn J List of all employees, job titles, and dales of employment. J Proof of warehouse/storage facility ownership or lease arrangements Minutes of all stockholders and board of directors meetings - Corporate by-laws and any amendments - Corporate bank resolution and bank signature cards Official Certificate of Formation and Operating Agreement with any amendments (for LLCs) = Optional Documents to Be Provided on Request The certi[ving agency fo which you are appZving may require the submission of the following documents. If requested to provide these document, you must suppZv them with your application or at the on-site visit. L Proof of citizenship Insurance agreements for each tmck owned or operated by your firm - Audited financial statements (if available) - Tmst agreements held by any owner claiming disadvantaged status Year-end balance sheets and income statements for the past 3 years (or life affirm, !{less than three years) = = Suppliers List of product lines carried and list of distribution equipment owned and/or leased = Corporation or LLC J Official Articles of Incorporation (5igned by the srate ojjicial) J Both sides of all corporate stock certificates and your firm's stock tnmsfcr ledger J Shareholders· Agrecment(s) U.S. DOT Uniform DEE/A CD BE Certification Application • Page 1022 of 15 BILLING CODE 4910–9X–C VerDate Sep<11>2014 20:42 Aug 10, 2018 Jkt 244001 PO 00000 Frm 00158 Fmt 4703 Sfmt 4703 E:\FR\FM\13AUN1.SGM 13AUN1 EN13AU18.061</GPH> sradovich on DSK3GMQ082PROD with NOTICES Partnership or Joint Venture J Original and any amended Partnership or Joint Venture Agreements Federal Register / Vol. 83, No. 156 / Monday, August 13, 2018 / Notices Appendix B to Part 26—Uniform Report of DBE Awards or Commitments and Payments Form sradovich on DSK3GMQ082PROD with NOTICES 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. 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 Race Conscious and Race Neutral projections (both of which include genderconscious/neutral projections). The Race 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 race conscious measure. The Race 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 VerDate Sep<11>2014 20:42 Aug 10, 2018 Jkt 244001 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 sub contracted 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. Except for the very rare case of DBE-set asides permitted under 49 CFR part 26, all prime contracts awarded to DBES are regarded as race-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 Race Neutral methods. See the definition of Race 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 Race 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 filling 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 dollars 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 PO 00000 Frm 00159 Fmt 4703 Sfmt 4703 40139 exceed the sum of all prime contract amounts awarded in those periods. 9(B). Provide the total number of all sub contracts assisted with DOT funds that were awarded or committed during this reporting period. 9(C). From the total dollar amount of sub contracts awarded/committed this period in item 9(A), provide the total dollar amount awarded in sub contracts to DBEs. 9(D). From the total number of sub contracts awarded or committed in item 9(B), specify the number of sub contracts awarded or committed to DBEs. 9(E). From the total dollar amount of sub contracts awarded or committed to DBEs this period, provide the amount in dollars to DBEs using Race Conscious measures. 9(F). From the total number of sub contracts awarded or committed to DBEs this period, provide the number of sub contracts awarded or committed to DBEs using Race Conscious measures. 9(G). From the total dollar amount of sub contracts awarded/committed to DBEs this period, provide the amount in dollars to DBEs using Race Neutral measures. 9(H). From the total number of sub contracts awarded/committed to DBEs this period, provide the number of sub contracts awarded to DBEs using Race Neutral measures. 9(I). Of all subcontracts awarded this reporting period, calculate the percentage going to DBEs. 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: Breakdown by Ethnicity & Gender of Contracts Awarded to DBEs This Period 11–17. Further breakdown the contracting activity with DBE involvement. The Total Dollar Amount to DBEs in 17(C) should equal the Total Dollar Amount to DBEs in 10(C). Likewise, the total number of contracts to DBEs in 17(F) should equal the Total Number of Contracts to DBEs in 10(D). Line 16: The ‘‘Non-Minority’’ category is reserved for any firms whose owners are not members of the presumptively disadvantaged groups already listed, but who are either ‘‘women’’ OR eligible for the DBE program on an individual basis. All DBE firms must be certified by the Unified Certification Program to be counted in this report. E:\FR\FM\13AUN1.SGM 13AUN1 40140 Federal Register / Vol. 83, No. 156 / Monday, August 13, 2018 / Notices sradovich on DSK3GMQ082PROD with NOTICES Section C: 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 and sub-contracts where work was performed during the reporting period. 18(B). Provide the total dollar amount paid to all firms performing work on contracts. 18(C). From the total number of contracts provided in 18(A) provide the total number of contracts that are currently being performed by DBE firms for which payments have been made. 18(D). From the total dollar amount paid to all firms in 18(A), provide the total dollar value paid to DBE firms currently performing work during this period. 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 firm may be providing supplies or services on all three contracts. This field should only list the number of DBE firms 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 18(B). Round the percentage to the nearest tenth. Section D: 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 used Race Conscious measures. Race Conscious contracts are those with contract goals or another race conscious measure. 19(B). Provide the total dollar value of prime contracts completed this reporting period that had race 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 Race Conscious contracts. 19(D). Provide the actual total DBE participation in dollars on the race conscious contracts completed this reporting period. 19(E). Of all the contracts completed this reporting period using Race 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 Race Neutral measures. 20(C). This field is closed. 21(A)–21(D). Calculate the totals for each column by adding the race conscious and neutral figures provided in each row above. VerDate Sep<11>2014 20:42 Aug 10, 2018 Jkt 244001 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. Left blank for future use. 24. Signature of the Authorized Representative. 25. Phone number of the Authorized Representative. **Submit your completed report to your Regional or Division Office. subject to the Regulatory Flexibility Act (5 U.S.C. chapter 6). Donna Hansberry, Chief, Appeals. [FR Doc. 2018–17286 Filed 8–10–18; 8:45 am] BILLING CODE 4830–01–P DEPARTMENT OF VETERANS AFFAIRS Privacy Act of 1974; System of Records BILLING CODE 4910–9X–P Department of Veterans Affairs (VA), Debt Management Center. ACTION: Notice of modified system of records. DEPARTMENT OF THE TREASURY SUMMARY: [FR Doc. 2018–17301 Filed 8–10–18; 8:45 am] Internal Revenue Service Art Advisory Panel—Notice of Availability of Report of 2017 Closed Meetings Internal Revenue Service, Treasury. ACTION: Notice. AGENCY: Pursuant to the Federal Advisory Committee Act, and the Government in the Sunshine Act, a report summarizing the closed meeting activities of the Art Advisory Panel during Fiscal Year 2017 has been prepared. A copy of this report has been filed with the Assistant Secretary for Management of the Department of the Treasury. DATES: Effective Date: This report is available August 2, 2018. ADDRESSES: The report is available at https://www.irs.gov/compliance/ appeals/art-appraisal-services. FOR FURTHER INFORMATION CONTACT: Maricarmen R. Cuello, AP:SPR:AAS, Internal Revenue Service/Appeals, 51 SW 1st Avenue, Room 1014, Miami, FL 33130, Telephone number (305) 982– 5364 (not a toll free number). SUPPLEMENTARY INFORMATION: Pursuant to 5 U.S.C. App. 2, section 10(d), of the Federal Advisory Committee Act, and 5 U.S.C. 552b, of the Government in the Sunshine Act, a report summarizing the closed meeting activities of the Art Advisory Panel during Fiscal Year 2017 has been prepared. A copy of this report has been filed with the Assistant Secretary for Management of the Department of the Treasury. It has been determined that this document is not a major rule as defined in Executive Order 12291 and that a regulatory impact analysis is, therefore, not required. Additionally, this document does not constitute a rule SUMMARY: PO 00000 Frm 00160 Fmt 4703 Sfmt 4703 AGENCY: The Privacy Act of 1974 (5 U.S.C. 522a (e) (4)) requires that all agencies publish in the Federal Register a notice of the existence and character of their systems of records. Notice is hereby given that the Department of Veterans Affairs (VA) is modifying a system of records entitled ‘‘Centralized Accounts Receivable System/ Centralized Accounts Receivable OnLine System (CARS/CAROLS) (88VA244)’’. This system was previously called ‘‘Accounts Receivable Records VA’’ (88VA244). This system had also been previously numbered ‘‘88VA20A6’’. DATES: Comments on this modified system of records must be received no later than September 12, 2018. If no public comment is received during the period allowed for comment, or unless otherwise published in the Federal Register by VA, the modified system will become effective a minimum of 30 days after publication in the Federal Register. If VA receives public comments, VA shall review the comments to determine whether any changes to the notice are necessary. ADDRESSES: Written comments may be submitted through www.Regulations.gov; by mail or handdelivery to Director, Regulation Policy and Management (00REG), Department of Veterans Affairs, 810 Vermont Ave. NW, Room 1064, Washington, DC 20420; or by fax to (202) 273–9026 (not a toll-free number). Comments should indicate that they are submitted in response to ‘‘Centralized Accounts Receivable System/Centralized Accounts Receivable On-Line System (CARS/CAROLS)’’. Copies of comments received will be available for public inspection in the Office of Regulation Policy and Management, Room 1063B, between the hours of 8:00 a.m. and 4:30 p.m., Monday through Friday (except holidays). Please call (202) 461–4902 for E:\FR\FM\13AUN1.SGM 13AUN1

Agencies

DEPARTMENT OF TRANSPORTATION

[Federal Register Volume 83, Number 156 (Monday, August 13, 2018)]
[Notices]
[Pages 40117-40140]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2018-17301]


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DEPARTMENT OF TRANSPORTATION

[Docket No. DOT-OST-2018-0075]


Request for Comments of a Previously Approved Information 
Collection(s)

AGENCY: Office of the Secretary, DOT.

ACTION: Notice and request for comments.

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SUMMARY: In accordance with the Paperwork Reduction Act of 1995, this 
notice announces that the Information Collection Request (ICR) 
abstracted below is being forwarded to the Office of Management and 
Budget (OMB) for review and comment. A Federal Register Notice with a 
60-day comment period soliciting comments on the information collection 
was published on June 4, 2018. One comment was received that does not 
warrant any adjustments to the forms.

DATES: Comments must be submitted on or before September 12, 2018.

ADDRESSES: Send comments regarding the burden estimate, including 
suggestions for reducing the burden, to the Office of Management and 
Budget, Attention: Desk Officer for the Office of the Secretary of 
Transportation, 725 17th Street NW, Washington, DC 20503.
    Comments are invited on: Whether the proposed collection of 
information is necessary for the proper performance of the functions of 
the Department, including whether the information will have practical 
utility; the accuracy of the Department's estimate of the burden of the 
proposed information collection; ways to enhance the quality, utility 
and clarity of the information to be collected; and ways to minimize 
the burden of the collection of information on respondents, including 
the use of automated collection techniques or other forms of 
information technology.

FOR FURTHER INFORMATION CONTACT: Mr. Marc Pentino, Departmental Office 
of Civil Rights, Office of the Secretary, U.S. Department of 
Transportation, 1200 New Jersey Avenue SE, Washington, DC 20590, (202) 
366-6968, or at [email protected].

SUPPLEMENTARY INFORMATION:
    Title: Disadvantaged Business Enterprise Program Collections.
    OMB Control Number: 2105-0510.
    Type of Request: Renewal of a Previously Approved Information 
Collection.
    Abstract: The following information collections are associated with 
the U.S. Department of Transportation's (DOT) Disadvantaged Business 
Enterprise (DBE) program: Uniform Report of DBE Awards or Commitments 
and Payments, Uniform Certification Application Form, Annual Affidavit 
of No Change, DOT Personal Net Worth Form, and Reporting Requirements 
for Percentages of DBEs in Various Categories. All five collections 
were previously approved under one OMB Control Number (2105-0510) to 
allow DOT to more efficiently administer the DBE program. The DBE 
program is mandated by statute, including Section 1101(b) of the Fixing 
America's Surface Transportation Act (FAST Act) (Pub. L. 114-94) and 49 
U.S.C. 47113. DOT's final regulations implementing these statutes are 
49 CFR parts 23 and 26. The information to be collected is necessary 
because it helps to ensure that State and local recipients that let 
federally-funded contracts carry out their mandated responsibility to 
provide a level playing field for small businesses owned and controlled 
by socially and economically disadvantaged individuals.

Uniform Report of DBE Awards/Commitments and Payments

    Affected Public: DOT financially-assisted State and local 
transportation agencies.

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    Number of Respondents: 1,250.
    Frequency: Once/twice per year.
    Number of Responses: One/two.
    Total Annual Burden: 9,000 hours.

Uniform Certification Application Form

    Affected Public: Firms applying to be certified as DBEs.
    Number of Respondents: 9,500.
    Frequency: Once during initial certification.
    Number of Responses: One.
    Total Annual Burden: 76,000 hours.

Annual Affidavit of No Change

    Affected Public: Certified DBEs.
    Number of Respondents: Approximately 38,465 certified DBE firms.
    Frequency: Once per year.
    Number of Responses: One.
    Total Annual Burden: 57,698 hours.

Personal Net Worth Form

    Affected Public: Firms applying to be DBEs.
    Number of Respondents: 9,500.
    Frequency: Once.
    Number of Responses: One.
    Total Annual Burden: 19,000 hours.

Percentage of DBEs in Various Categories

    Affected Public: States (through their Unified Certification 
Programs).
    Number of Respondents: 53 (50 states, plus the District of 
Columbia, Puerto Rico, and the Virgin Islands).
    Frequency: Once per year.
    Number of Responses: One.
    Total Annual Burden: 161.6 hours.

    Authority: The Paperwork Reduction Act of 1995; 44 U.S.C. 
Chapter 35, as amended; and 49 CFR 1:48.

    Issued in Washington, DC.
Charles E. James, Sr.,
Director, Departmental Office of Civil Rights, U.S. Department of 
Transportation.
BILLING CODE 4910-9X-P

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BILLING CODE 4910-9X-C

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Appendix B to Part 26--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.
    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 Race Conscious and Race Neutral projections 
(both of which include gender-conscious/neutral projections). The 
Race 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 race conscious measure. The Race 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 sub contracted 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. Except for the very 
rare case of DBE-set asides permitted under 49 CFR part 26, all 
prime contracts awarded to DBES are regarded as race-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 Race 
Neutral methods. See the definition of Race 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 Race 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 filling 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 dollars 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 sub contracts assisted 
with DOT funds that were awarded or committed during this reporting 
period.
    9(C). From the total dollar amount of sub contracts awarded/
committed this period in item 9(A), provide the total dollar amount 
awarded in sub contracts to DBEs.
    9(D). From the total number of sub contracts awarded or 
committed in item 9(B), specify the number of sub contracts awarded 
or committed to DBEs.
    9(E). From the total dollar amount of sub contracts awarded or 
committed to DBEs this period, provide the amount in dollars to DBEs 
using Race Conscious measures.
    9(F). From the total number of sub contracts awarded or 
committed to DBEs this period, provide the number of sub contracts 
awarded or committed to DBEs using Race Conscious measures.
    9(G). From the total dollar amount of sub contracts awarded/
committed to DBEs this period, provide the amount in dollars to DBEs 
using Race Neutral measures.
    9(H). From the total number of sub contracts awarded/committed 
to DBEs this period, provide the number of sub contracts awarded to 
DBEs using Race Neutral measures.
    9(I). Of all subcontracts awarded this reporting period, 
calculate the percentage going to DBEs. 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: Breakdown by Ethnicity & Gender of Contracts Awarded to 
DBEs This Period

    11-17. Further breakdown the contracting activity with DBE 
involvement. The Total Dollar Amount to DBEs in 17(C) should equal 
the Total Dollar Amount to DBEs in 10(C). Likewise, the total number 
of contracts to DBEs in 17(F) should equal the Total Number of 
Contracts to DBEs in 10(D).
    Line 16: The ``Non-Minority'' category is reserved for any firms 
whose owners are not members of the presumptively disadvantaged 
groups already listed, but who are either ``women'' OR eligible for 
the DBE program on an individual basis. All DBE firms must be 
certified by the Unified Certification Program to be counted in this 
report.

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Section C: 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 and sub-contracts where 
work was performed during the reporting period.
    18(B). Provide the total dollar amount paid to all firms 
performing work on contracts.
    18(C). From the total number of contracts provided in 18(A) 
provide the total number of contracts that are currently being 
performed by DBE firms for which payments have been made.
    18(D). From the total dollar amount paid to all firms in 18(A), 
provide the total dollar value paid to DBE firms currently 
performing work during this period.
    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 firm may be providing 
supplies or services on all three contracts. This field should only 
list the number of DBE firms 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 18(B). Round the 
percentage to the nearest tenth.

Section D: 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 used Race Conscious measures. Race 
Conscious contracts are those with contract goals or another race 
conscious measure.
    19(B). Provide the total dollar value of prime contracts 
completed this reporting period that had race 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 Race Conscious contracts.
    19(D). Provide the actual total DBE participation in dollars on 
the race conscious contracts completed this reporting period.
    19(E). Of all the contracts completed this reporting period 
using Race 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 Race Neutral measures.
    20(C). This field is closed.
    21(A)-21(D). Calculate the totals for each column by adding the 
race conscious and 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. Left blank for future use.
    24. Signature of the Authorized Representative.
    25. Phone number of the Authorized Representative.
    **Submit your completed report to your Regional or Division 
Office.

[FR Doc. 2018-17301 Filed 8-10-18; 8:45 am]
 BILLING CODE 4910-9X-P

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