Referral of Information

ICR 201012-1513-001

OMB: 1513-0003

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Form and Instruction
Modified
Supplementary Document
2010-12-10
Supplementary Document
2007-10-10
Supporting Statement A
2010-12-10
IC Document Collections
ICR Details
1513-0003 201012-1513-001
Historical Active 200710-1513-002
TREAS/TTB
Referral of Information
Reinstatement without change of a previously approved collection   No
Regular
Approved without change 03/27/2011
Retrieve Notice of Action (NOA) 02/02/2011
  Inventory as of this Action Requested Previously Approved
03/31/2014 36 Months From Approved
500 0 0
500 0 0
0 0 0

When we discover potential violations of Federal, State, or local, we use TTB F 5000.21 to make referrals to Federal, State, or local agencies to determine if they plan to take action, and to internally refer potential violations of TTB administered statutes. We also use TTB F 5000.21 to evaluate effectiveness of these referrals.

None
None

Not associated with rulemaking

  75 FR 59797 09/28/2010
76 FR 5856 02/02/2011
No

2
IC Title Form No. Form Name
Referral of Information TTB F 5000.21 Referral of Information
Referral of Information TTB F 5000.21 Referral of Information

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 500 0 0 0 0 500
Annual Time Burden (Hours) 500 0 0 0 0 500
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$2,318
No
No
No
No
No
Uncollected
Mary Wood 202 927-8185 [email protected]

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
02/02/2011


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