Information Collection

Consumer Pilot Test Survey for the Converter Box Coupon Program

IC 183346 under ICR 200801-0660-001 · OMB 0660-0025.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Consumer Pilot Test Survey Consumer Pilot Test Survey for the Converter Box Coupon Program	Form and Instruction
Consumer Pilot Test Survey 0660.ConsumerSurvey.CoupProg.PilotTest.01908.doc	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

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 and Instruction	None			http:\\www.dtv.gov	Yes	Yes	Fillable Fileable

Line of Business: General Government

Subfunction: Legislative Functions

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 20 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,000	1,000
Annual IC Time Burden (Hours)	250	250
Annual IC Cost Burden (Dollars)	0	0

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.

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