Document Name Document Type
Form 3170-XXXX Nomination Form Form
3170-XXXX Application to Serve on Advisory Board, Body, Panel, Com Application to Serve on Advisory Board Body Panel Committee or Group (Background Information - Short Form).pdf Form
3170-XXXX Application to Serve on Advisory Board, Body, Panel, Com Application to Serve on Advisory Board Body Panel Committee or Group (Background Information - Long Form).pdf Form
3170-XXXX Application to Serve on Advisory Board, Body, Panel, Com Application to Serve on Advisory Board Body Panel Committee or Group (Positions).pdf Form
3170-XXXX Application to Serve on Advisory Board, Body, Panel, Com Application to Serve on Advisory Board Body Panel Committee or Group (Liabilities).pdf Form
3170-XXXX Application to Serve on Advisory Board, Body, Panel, Com Application to Serve on Advisory Board Body Panel Committee or Group (Affiliations and Representations).pdf Form
3170-XXXX Application to Serve on Advisory Board, Body, Panel, Com Application to Serve on Advisory Board Body Panel Committee or Group (Assets and Income).pdf Form
3170-XXXX Application to Serve on Advisory Board, Body, Panel, Com Application to Serve on Advisory Board Body Panel Committee or Group (Full Version).pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Nomination Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	3170-XXXX	Application to Serve on Advisory Board, Body, Panel, Committee, or Group (Background Information - Short Form)	Application to Serve on Advisory Board Body Panel Committee or Group (Background Information - Short Form).pdf	Yes	No	Fillable Printable
Form	3170-XXXX	Application to Serve on Advisory Board, Body, Panel, Committee, or Group (Background Information - Long Form)	Application to Serve on Advisory Board Body Panel Committee or Group (Background Information - Long Form).pdf	Yes	No	Fillable Printable
Form	3170-XXXX	Application to Serve on Advisory Board, Body, Panel, Committee, or Group (Positions)	Application to Serve on Advisory Board Body Panel Committee or Group (Positions).pdf	Yes	No	Fillable Printable
Form	3170-XXXX	Application to Serve on Advisory Board, Body, Panel, Committee, or Group (Liabilities)	Application to Serve on Advisory Board Body Panel Committee or Group (Liabilities).pdf	Yes	No	Fillable Printable
Form	3170-XXXX	Application to Serve on Advisory Board, Body, Panel, Committee, or Group (Affiliations and Representations)	Application to Serve on Advisory Board Body Panel Committee or Group (Affiliations and Representations).pdf	Yes	No	Fillable Printable
Form	3170-XXXX	Application to Serve on Advisory Board, Body, Panel, Committee, or Group (Assets and Income)	Application to Serve on Advisory Board Body Panel Committee or Group (Assets and Income).pdf	Yes	No	Fillable Printable
Form	3170-XXXX	Application to Serve on Advisory Board, Body, Panel, Committee, or Group (Full Version)	Application to Serve on Advisory Board Body Panel Committee or Group (Full Version).pdf	Yes	No	Fillable Printable

Federal Enterprise Architecture Business Reference Module

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.

Nomination Form

Advisory Boards, Groups and Committees

OMB: 3170-0037

IC ID: 204699

View Information Collection (IC)