Information Collection

Redirection of Checkoff Assessments

IC 222421 under ICR 201904-0581-003 · OMB 0581-0294.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form QSBC-1 Redirection of Checkoff Assessments	Form
QSBC-1 Producer Redirection of Checkoff assessments Form QSBC-1 - CBB Producer Redirection of Checkoff Assessment 11 14 19.pdf	Form
QSSB-1 Producer Redirection of Checkoff Assessments Form QSSB-1 - USB Producer Redirection of Checkoff Assesment 11 14 19.pdf	Form

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	QSBC-1	Producer Redirection of Checkoff assessments Form	QSBC-1 - CBB Producer Redirection of Checkoff Assessment 11 14 19.pdf		No		Paper Only
Form	QSSB-1	Producer Redirection of Checkoff Assessments Form	QSSB-1 - USB Producer Redirection of Checkoff Assesment 11 14 19.pdf		No		Paper Only

Line of Business: Economic Development

Subfunction: Business and Industry Development

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 30

Number of Respondents for Small Entity: 30

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	30	30
Annual IC Time Burden (Hours)	2	2
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.