APPLICATION FOR COMMISSION

ICR 198403-0910-007

OMB: 0910-0010

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
109295 Migrated
ICR Details
0910-0010 198403-0910-007
Historical Active 198102-0910-002
HHS/FDA
APPLICATION FOR COMMISSION
Extension without change of a currently approved collection   No
Regular
Approved without change 05/21/1984
Retrieve Notice of Action (NOA) 03/29/1984
  Inventory as of this Action Requested Previously Approved
05/31/1987 05/31/1987 03/31/1984
100 0 100
100 0 100
0 0 0

FORM FDA 1777 IS USED TO OBTAIN BACKGROUND INFORMATION ON STATE/LOCAL OFFICIALS APPLYING FOR AN FDA COMMISSION UNDER SECTION 702(A) OF THE FD&C ACT AND TO DETERMINE THE INDIVIDUALS' QUALIFICATIONS IN CARRYING OUT THE ACTIVITIES SPECIFIED IN HIS/HER FDA COMMISSION IN SPECIFIC PROGRAM AREAS.

None
None


No

1
IC Title Form No. Form Name
APPLICATION FOR COMMISSION FD-1777

  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 100 100 0 0 0 0
Annual Time Burden (Hours) 100 100 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.
03/29/1984


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