Converter Box Coupon Program-Consumer and Retailer Pilot Test Surveys

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Retailer Pilot Test Survey	Form and Instruction	New	Available
Consumer Pilot Test Survey	Form and Instruction	New	Available
0660.CoupProg.TestPilot.SuppStmt.doc	Supporting Statement A	Uploaded 2008-01-11	Available
0660.CIO Ltr to OMB.CoupProg.PilotTest.pdf	Supplementary Document	Uploaded 2008-01-10	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
183373	Retailer Pilot Test Survey for the Converter Box Coupon Program	Form and Instruction	New	Retailer Pilot Test Survey
183346	Consumer Pilot Test Survey for the Converter Box Coupon Program	Form and Instruction	New	Consumer Pilot Test Survey

ICR Details

OMB Control No: 0660-0025	ICR Reference No: 200801-0660-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: DOC/NTIA	Agency Tracking No:
Title: Converter Box Coupon Program-Consumer and Retailer Pilot Test Surveys
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 01/25/2008
OIRA Conclusion Action: Approved without change	Conclusion Date: 01/31/2008
Retrieve Notice of Action (NOA)	Date Received in OIRA: 01/11/2008
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2008	6 Months From Approved
Responses	1,100	0	0
Time Burden (Hours)	275	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Congress directed the National Telecommunications and Information Administration (NTIA) to create and implement a program to provide coupons for consumers to purchase digital-to-analog converter boxes. (See Title III of the Deficit Reduction Act of 2005, Pub. L. No. 109-171, 120 Stat. 4, 21 (Feb. 8, 2006)). These converter boxes are necessary for consumers who wish to continue receiving broadcast programming over the air using analog-only television sets after February 17, 2009 - - the date that television stations are required by law to cease analog broadcasting.

Emergency Justfication: NTIA is proposing a pilot test for the converter box coupon program whereby volunteers (consumers) will test all aspects of the coupon program. The pilot test is necessary to identify any flaws in the system prior to a nationwide launch. At the end of the pilot program, volunteers will be asked to complete a survey describing their experience in applying for the coupon, receiving the coupon, and redeeming the coupon for an eligible converter box. Retailers will also participate in the pilot test and provide feedback on their experience in the process.

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Authorizing Statute(s): None

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Consumer Pilot Test Survey for the Converter Box Coupon Program	None	Consumer Pilot Test Survey
Retailer Pilot Test Survey for the Converter Box Coupon Program	None	Retailer Pilot Test Survey

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	1,100	0	0	1,100	0	0
Annual Time Burden (Hours)	275	0	0	275	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new collection.

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Annual Cost to Federal Government:

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 01/11/2008

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