Information Collection Request

Request for Waiver of Service Obligation, Request for Deferment of Service Obligation, Application for Review

ICR 201106-2133-002 · OMB 2133-0510 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form MA-935 Request for Waiver of Service Obligation, request for Deferment of Service Obligation, Application for Review Form and Instruction Modified Available
30-day FR Notice.pdf Supplementary Document Uploaded 2011-06-07 Available
60-Day FR Notice.pdf Supplementary Document Uploaded 2011-06-07 Available
Supporting Statement.docx Supporting Statement A Uploaded 2011-11-15 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
26651 Request for Waiver of Service Obligation, request for Deferment of Service Obligation, Application for Review Form and Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
11/30/2014 36 Months From Approved 11/30/2011
11 0 21
3 0 8
7 0 0





table that charts list of burden
  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 11 21 0 -10 0 0
Annual Time Burden (Hours) 3 8 0 -5 0 0
Annual Cost Burden (Dollars) 7 0 0 7 0 0


Reginfo record details
  No