TRADE NAME REQUEST FORM FOR NOHS

ICR 197611-0920-003

OMB: 0920-0022

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
165658 Migrated
ICR Details
0920-0022 197611-0920-003
Historical Active 197609-0920-001
HHS/CDC
TRADE NAME REQUEST FORM FOR NOHS
No material or nonsubstantive change to a currently approved collection   No
Emergency 11/12/1976
Approved with change 11/12/1976
Retrieve Notice of Action (NOA) 11/12/1976
  Inventory as of this Action Requested Previously Approved
01/31/1978 01/31/1978 01/31/1977
2,500 0 2,500
5,000 0 5,000
0 0 0



None
None


No

1
IC Title Form No. Form Name
TRADE NAME REQUEST FORM FOR NOHS CDC NIOSH 09

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 2,500 2,500 0 0 0 0
Annual Time Burden (Hours) 5,000 5,000 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
11/12/1976


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