Information Collection

Certifications

IC 203469 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 Certifications	Form
3170-XXXX Global Certification Global certification.docx	Form
3170-XXXX Entity-specific Certification Entity-specific certification.docx	Form
3170-XXXX Non-entity-specific Certification Non-entity-specific certification.docx	Form

IC Title:

Certifications

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	3170-XXXX	Global Certification	Global certification.docx	Yes	Yes	Fillable Printable
Form	3170-XXXX	Entity-specific Certification	Entity-specific certification.docx	Yes	Yes	Fillable Printable
Form	3170-XXXX	Non-entity-specific Certification	Non-entity-specific certification.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: 100

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	100	100
Annual IC Time Burden (Hours)	17	17
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.