Nomination Form

Advisory Boards, Groups and Committees

Documents and Forms

Document Name Document Type
Form 3170-XXXX Nomination Form Form
3170-XXXX Nomination Form 2012 07 20_Advisory Board Nomination Form.docx Form

Information Collection (IC) Details

IC Title:	Nomination Form	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection 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 %

	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

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.