This collection
is approved for six months and with changes necessary to bring this
collection into compliance with the Privacy Act by providing the
public a sufficient Privacy Act notice as required by 5 U.S.C.
552a(e)(3).
Inventory as of this Action
Requested
Previously Approved
08/31/2005
08/31/2005
100
0
0
100
0
0
0
0
0
This form is used to collect
information from candidates for advisory councils. This form is
needed to determine eligibility potential conflict-of-interest and
mailing data.
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.