Information Collection

Application to Serve as a Small Entity Representative

IC 204701 under ICR 201411-3170-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Application to Serve as a Small Entity Representative	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

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	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 %

	Approved	Previously Approved
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

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.