Information Collection

Retailer Pilot Test Survey for the Converter Box Coupon Program

IC 183373 under ICR 200801-0660-001 · OMB 0660-0025.

Documents and Forms

Documents and forms in this information collection
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

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	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 %

table that charts list of burden
	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

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.