Information Collection

Panel Application Form

IC 203470 under ICR 201206-3170-003 · OMB 3170-0021.

Documents and Forms

Document Name Document Type
Form 3170-XXXX Panel Application Form Form
3170-XXXX Panel Application Form 2012_07_20_SERS Form.doc Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Panel Application 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	Panel Application Form	2012_07_20_SERS Form.doc		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: 100

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