Information Collection

Certification for Retailers to Accept and Redeem Coupons for the Purchase of a Digital-to-Analog Converter Box

IC 44328 under ICR 200701-0660-005 · OMB 0660-0020.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0660-0020 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form DTV-1 Certification for Retailers to Accept and Redeem Coupons for the Purchase of a Digital-to-Analog Converter Box	Form
DTV-1 RETAILER DATA COLLECTION FORM OMB Form 2 Retailer Data Collection-1.doc	Form

IC Title:

Certification for Retailers to Accept and Redeem Coupons for the Purchase of a Digital-to-Analog Converter Box

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	DTV-1	RETAILER DATA COLLECTION FORM	OMB Form 2 Retailer Data Collection-1.doc		No		Paper Only

Line of Business: General Government

Subfunction: Legislative Functions

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 4,000

Number of Respondents for Small Entity: 3,000

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	4,000	4,000
Annual IC Time Burden (Hours)	1,000	1,000
Annual IC Cost Burden (Dollars)	75,000	75,000

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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