Information Collection

Nomination Form

IC 203468 under ICR 201206-3170-003 · OMB 3170-0021.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 3170-XXXX Nomination Form	Form
3170-XXXX Nomination Form 2012 07 20_Advisory Board Nomination Form.docx	Form

IC Title:

Nomination Form

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	3170-XXXX	Nomination Form	2012 07 20_Advisory Board Nomination Form.docx		Yes	Yes	Fillable Printable

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records

Title: Advisory Boards and Committees

FR Citation: 77 FR 12034

Number of Respondents: 200

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 80 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	200	200
Annual IC Time Burden (Hours)	200	200
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.