Information Collection

Membership nomination form

IC 198397 under ICR 201712-1076-001 · OMB 1076-0179.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1076-0179 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Call for Noms.docx	Instruction
Membership Nomination Form OMB# 1076-0179 (Membership Nomination FORM) Amended v4.pdf	Form

IC Title:

Membership nomination form

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			Call for Noms.docx		Yes	Yes	Printable Only
Form	N/A	Membership Nomination Form	OMB# 1076-0179 (Membership Nomination FORM) Amended v4.pdf		Yes	Yes	Fillable Printable

Line of Business: Education

Subfunction: Elementary, Secondary, and Vocational Education

Privacy Act System of Records

Title: Employee Administrative Records

FR Citation: 64 FR 19384

Number of Respondents: 20

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 90 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	20	-10	30
Annual IC Time Burden (Hours)	20	-10	30
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.