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

Documents and Forms

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.