REFERENCE QUESTIONNAIRE

ICR 197705-0412-008

OMB: 0412-0016

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
162294 Migrated
ICR Details
0412-0016 197705-0412-008
Historical Active 197512-0412-001
AID
REFERENCE QUESTIONNAIRE
No material or nonsubstantive change to a currently approved collection   No
Emergency 05/26/1977
Approved with change 05/26/1977
Retrieve Notice of Action (NOA) 05/26/1977
  Inventory as of this Action Requested Previously Approved
11/30/1980 11/30/1980 11/30/1980
4,000 0 5,000
2,000 0 3,750
0 0 0



None
None


No

1
IC Title Form No. Form Name
REFERENCE QUESTIONNAIRE AID 410-3

  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 4,000 5,000 0 0 -1,000 0
Annual Time Burden (Hours) 2,000 3,750 0 0 -1,750 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.
05/26/1977


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