Information Collection

0012 Application fee for person disciplined, convicted of a felony or certain misdemeanors under §11.7(h)

IC 203105 under ICR 201301-0651-003 · OMB 0651-0072.

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IC Title:

0012 Application fee for person disciplined, convicted of a felony or certain misdemeanors under §11.7(h)

Agency IC Tracking Number:

9014

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 37 CFR 1.21(a)(10)

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

Line of Business: Economic Development

Subfunction: Intellectual Property Protection

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 13

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to New Statute	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	13	9	4
Annual IC Time Burden (Hours)	0	0	0
Annual IC Cost Burden (Dollars)	20,800	14,400	6,400

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.