Information Collection

TV and Tipover

IC 194736 under ICR 201009-3041-004 · OMB 3041-0135.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3041-0135 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Survey 04 TV and Tipover	Form and Instruction
Survey 04 TV and tipovers OMB0135 TV Tipovers.pdf www.cpsc.gov/cgibin/cof/login.aspx	Form and Instruction

IC Title:

TV and Tipover

Agency IC Tracking Number:

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	Survey 04	TV and tipovers	OMB0135 TV Tipovers.pdf	https://www.cpsc.gov/cgibin/cof/login.aspx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 500

Number of Respondents for Small Entity: 500

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	500	500
Annual IC Time Burden (Hours)	42	42
Annual IC Cost Burden (Dollars)	1,225	1,225

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.