Information Collection

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

IC 44328 under ICR 200710-0660-002 · OMB 0660-0020.

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
Retailer Agreement 0660.0020.Retailer_Agreement.pdf To be Determined	Form and Instruction

IC Title:

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
Form and Instruction	None	Retailer Agreement	0660.0020.Retailer_Agreement.pdf	To be Determined	Yes	Yes	Fillable Fileable

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	Previously Approved
Annual Number of Responses for this IC	4,000	0	4,000
Annual IC Time Burden (Hours)	2,000	1,000	1,000
Annual IC Cost Burden (Dollars)	75,000	0	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.