Annual Certification Letter

Federal Tax Offset, Administrative Offset, and Passport Denial Programs

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0161 can be found here:

Documents and Forms

Document Name Document Type
PRA - Federal Offset - Annual Cert Letter 4-01-13.doc Instruction

Information Collection (IC) Details

IC Title:	Annual Certification Letter	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			PRA - Federal Offset - Annual Cert Letter 4-01-13.doc		Yes	No	Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title: Location and Collection System	FR Citation: 78 FR 5812

Number of Respondents: 54	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	54	54
Annual IC Time Burden (Hours)	22	22
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.