Retailer 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
Retailer Pilot Test Survey for the Converter Box Coupon Program Form and Instruction
Retailer Pilot Test Survey 0660.RetailerSurvey.CoupProg.PilotTest.010908.doc Form and Instruction

Information Collection (IC) Details

IC Title:	Retailer 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	Retailer Pilot Test Survey	0660.RetailerSurvey.CoupProg.PilotTest.010908.doc		No		Paper Only

Line of Business: General Government

Subfunction: Legislative Functions

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 100	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	25	25
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.