Community Based Outlet Program

ICR 200111-1545-005

OMB: 1545-1753

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
19289 Migrated
ICR Details
1545-1753 200111-1545-005
Historical Active 200108-1545-033
TREAS/IRS
Community Based Outlet Program
Extension without change of a currently approved collection   No
Regular
Approved without change 01/25/2002
Retrieve Notice of Action (NOA) 11/26/2001
The agency is not required to display the expiration date.
  Inventory as of this Action Requested Previously Approved
01/31/2005 01/31/2005 03/31/2002
500 0 500
42 0 42
0 0 0

Form 10574 will be used by companies, businesses and government agencies to indicate their interest in participating in the IRS Community Based Outlet Program. This form will be returned to the Western Area Distribution Center for processing and order fulfillment.

None
None


No

1
IC Title Form No. Form Name
Community Based Outlet Program 10574

  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 500 500 0 0 0 0
Annual Time Burden (Hours) 42 42 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.
11/26/2001


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