The information provided on this form
determines whether an applicant is eligible to receive a Federal
license or permit. If an applicant applies for a license or permit
and has an arrest record charged with a violation of Federal or
State law and there is no record present of the disposition of the
cases(s), the form is sent to the custodian or records to ascertain
the disposition of the case.
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.