THIS INFORMATION COLLECTION IS APPROVED SUBJECT TO THE FOLLOWING LIMITATION: THE STATEMENT "NOT A COMPLAINT FORM" MUST BE DELETED. A STATEMENT MUST BE ADDED IN BOLD TYPE AT THE BOTTOM OF THE QUESTIONNAIRE BRIEFLY EXPLAINING THAT THIS FORM IS INTENDED AS A SURVEY ONLY, AND THAT THE PROCEDURES FOR FILING A COMPLAINT ARE EXPLAINED IN THE ACCOMPANYING BOOKLET. THIS SURVEY IS APPROVED THROUGH 5/31/84 ONLY. IF IT IS RESUBMITTED FOR OMB APPROVAL, THE JUSTIFICATION STATEMENT MUST INCLUDE (1) AN ANALYSIS OF THE DATA WHICH THE ICC HAS PREVIOUSLY COLLECTED, AND (2) A BRIEF DISCUSSION OF WHETHER THE ICC DEVOTES SUFFICIENT STAFF AND COMPUTER RESOURCES TO RECORDING AND REVIEWING CONSUMER RESPONSES TO THIS SURVEY TO WARRANT CONTINUED COLLECTION OF THIS DATA.
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.