Information Collection

Representative and Address Provisions

IC 4740 under ICR 200209-0651-001 · OMB 0651-0035.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0651-0035 can be found here:

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Document Name	Document Type

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IC Title:

Representative and Address Provisions

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:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?
Form	PTO/SB/122	No	No
Form	PTO/SB/124A	No	No
Form	PTP/SB/125A	No	No
Form	PTO/SB/83	No	No
Form	PTO/SB/125B	No	No
Form	PTO/SB/121	No	No
Form	PTO/SB/82	No	No
Form	PTO/SB/124B	No	No
Form	PTO/SB/81	No	No
Form	PTO/SB/123	No	No

Line of Business:

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 338,280

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	338,280	33,593	4,162	300,525
Annual IC Time Burden (Hours)	31,259	13,849	1,716	15,694
Annual IC Cost Burden (Dollars)	170,000	8,000	162,000	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded

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