Consumer Pilot Test Survey for the Converter Box Coupon Program

Converter Box Coupon Program-Consumer and Retailer Pilot Test Surveys

Documents and Forms

Document Name Document Type
Consumer Pilot Test Survey for the Converter Box Coupon Program Form and Instruction
Consumer Pilot Test Survey 0660.ConsumerSurvey.CoupProg.PilotTest.01908.doc http:\\www.dtv.gov Form and Instruction

Information Collection (IC) Details

IC Title:	Consumer Pilot Test Survey for the Converter Box Coupon Program	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	None	Consumer Pilot Test Survey	0660.ConsumerSurvey.CoupProg.PilotTest.01908.doc	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 %

	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

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.