APPLICATION TO BE LISTED UNDER THE VOTING RIGHTS ACT OF 1965

ICR 198209-3206-001

OMB: 3206-0076

Federal Form Document

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Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
3206-0076 198209-3206-001
Historical Active 198107-3206-002
OPM
APPLICATION TO BE LISTED UNDER THE VOTING RIGHTS ACT OF 1965
Reinstatement with change of a previously approved collection   No
Regular
Approved without change 09/14/1982
Retrieve Notice of Action (NOA) 09/01/1982
When next reprinted, form will be revised to include a Privacy Act statement per 5 USC 552(e)(3). A copy of the revised form is to be provided to OMB within 30 days.
  Inventory as of this Action Requested Previously Approved
08/31/1985 08/31/1985
250 0 0
83 0 0
0 0 0

UNDER THE VOTING RIGHTS ACT OF 1965, THE DEPARTMENT OF JUSTICE MAY REQUEST OPM TO EXAMINE THE QUALIFICATIONS OF PERSONS TO VOTE. THE OPM FORM 805 SERIES ELICITS INFORMATION FROM WHICH THIS DETERMINATION CAN BE MADE. IF ELIGIBLE, THE PERSON'S NAME IS CERTIFIED TO APPROPRIATE STATE OFFICIALS FOR ADDITION TO THE OFFICIAL VOTING LISTS.

None
None


No

1
IC Title Form No. Form Name
APPLICATION TO BE LISTED UNDER THE VOTING RIGHTS ACT OF 1965 OPM 805

  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 250 0 0 250 0 0
Annual Time Burden (Hours) 83 0 0 83 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
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.
09/01/1982


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