Information Collection

Death Of Injury Report, Orv Permit Undertaking, Orv Permit Affidavit

IC 117040 under ICR 198201-1004-021 · OMB 1004-0093.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type

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IC Title:

DEATH OF INJURY REPORT, ORV PERMIT UNDERTAKING, ORV PERMIT AFFIDAVIT

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Migrated

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?
Form	CA-6260-5	No	No
Form	6260-2	No	No
Form	6260-4	No	No

Line of Business:

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 200

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	200	200
Annual IC Time Burden (Hours)	67	67
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.