Information Collection

Application for Converter Box Coupons for Consumers using Post Office Boxes for Mail Receipt

IC 184527 under ICR 200809-0660-001 · OMB 0660-0026.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Application for Converter Box Coupons for Consumers using Post Office Boxes for Mail Receipt	Form and Instruction
Application for Converter Box Coupons for Consumers usin 0660[2].Draft PO Box Coupon Application..doc	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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	Application for Converter Box Coupons for Consumers using P.O. Boxes	0660[2].Draft PO Box Coupon Application..doc		Yes	Yes	Fillable Fileable

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 340,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	340,000	340,000
Annual IC Time Burden (Hours)	113,333	113,333
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.