Information Collection

Drug Offender's License Suspension Certification

IC 142000 under ICR 199106-2127-001 · OMB 2127-0003.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2127-0003 can be found here:

Documents and Forms

Document Name Document Type

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Information Collection (IC) Details

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IC Title:	DRUG OFFENDER'S LICENSE SUSPENSION CERTIFICATION	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?
Form	HS-62	No	No
Form	62A	No	No
Form	217	No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 57	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Previously Approved
Annual Number of Responses for this IC	57	57
Annual IC Time Burden (Hours)	528	528
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded

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