Specific Release Form

ICR 201206-2120-003

OMB: 2120-0740

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Supporting Statement A
2012-07-19
IC Document Collections
IC ID
Document
Title
Status
188937 Modified
ICR Details
2120-0740 201206-2120-003
Historical Active 200904-2120-004
DOT/FAA
Specific Release Form
Revision of a currently approved collection   No
Regular
Approved without change 01/30/2013
Retrieve Notice of Action (NOA) 09/28/2012
  Inventory as of this Action Requested Previously Approved
01/31/2016 36 Months From Approved 01/31/2013
270 0 270
23 0 23
0 0 0

Investigations are conducted under authority derived from Title 49, United States Code (U.S.C.), Sections 106, 40113, 40114, 46101, and 46104, the Aviation Drug Trafficking Control Act of 1984, the Anti-Drug Abuse Act of 1986, and the FAA Drug Enforcement Assistance Act of 1988, which is part of Public Law 100-690, also known as the Anti-Drug Abuse Act of 1988. The respondents are the SUBJECT (FAA employees, FAA Contractors, Pilots, or FAA job applicants) from whom additional information is needed to complete a thorough investigation.

US Code: 49 USC 40114 Name of Law: Reports and records
   US Code: 49 USC 46101 Name of Law: Complaints and investigations
   US Code: 49 USC 40113 Name of Law: Administrative
   US Code: 49 USC 46104 Name of Law: Evidence
  
None

Not associated with rulemaking

  77 FR 20093 04/03/2012
77 FR 36330 06/18/2012
Yes

1
IC Title Form No. Form Name
Specific Release Form 1600-81 Specific Release Form

  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 270 270 0 0 0 0
Annual Time Burden (Hours) 23 23 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$2,430
No
No
No
No
No
Uncollected
Elaine Stone-Arthur 2024935398

  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.
09/28/2012


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