Information Collection

Applications from Purchasers and Distributors

IC 204642 under ICR 201601-2070-001 · OMB 2070-0184.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form EPA Form 9600-04 Applications from Purchasers and Distributors	Form and Instruction
EPA Form 9600-04 Safer Choice Partner of the Year Application 2450-02_AttB_form_2016-01-19.docx www2.epa.gov/sites/production/files/2015-01/documents/poty2015_application.pdf	Form and Instruction

IC Title:

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 and Instruction	EPA Form 9600-04	Safer Choice Partner of the Year Application	2450-02_AttB_form_2016-01-19.docx	http://www2.epa.gov/sites/production/files/2015-01/documents/poty2015_application.pdf	Yes	No	Fillable Printable

Line of Business: Environmental Management

Subfunction: Pollution Prevention and Control

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 5

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	5	-5	10
Annual IC Time Burden (Hours)	75	-75	150
Annual IC Cost Burden (Dollars)	0	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.