Information Collection

135 - Disqualification

IC 179152 under ICR 200703-1010-002 · OMB 1010-0114.

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Information Collection (IC) Details

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IC Title:	135 - Disqualification	Agency IC Tracking Number:	omm-1010-0114-07

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 30 CFR 250.135

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Energy

Subfunction: Energy Conservation and Preparedness

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 50 %

	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	4	4
Annual IC Time Burden (Hours)	160	160
Annual IC Cost Burden (Dollars)	0	0

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