Information Collection

Application to Serve as a Small Entity Representative

IC 204701 under ICR 201304-3170-003 · OMB 3170-0037.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3170-0037 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 3170-XXXX Application to Serve as a Small Entity Representative	Form
3170-XXXX Application to Serve as a Small Entity Representative Application to Serve as a Small Entity Representative.pdf	Form

IC Title:

Application to Serve as a Small Entity Representative

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

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
Form	3170-XXXX	Application to Serve as a Small Entity Representative	Application to Serve as a Small Entity Representative.pdf		Yes	Yes	Fillable Printable

Line of Business: Economic Development

Subfunction: Financial Sector Oversight

Privacy Act System of Records

Title: Advisory Boards and Committees

FR Citation: 77 FR 12034

Number of Respondents: 1,700

Number of Respondents for Small Entity: 1,700

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 80 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,700	1,700
Annual IC Time Burden (Hours)	289	289
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.