Information Collection

EM Service Provider - Application (Application, EM Service Plan, 2 Units)

IC 237156 under ICR 201907-0648-009 · OMB 0648-0785.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0648-0785 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
EM Service Provider - Application (Application, EM Service Plan, 2 Units)	Form and Instruction
EM Provider Permit Application & Renewal Form EM Provider Permit Application & Renewal Form.docx	Form and Instruction

IC Title:

EM Service Provider - Application (Application, EM Service Plan, 2 Units)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 50 CFR 660.603(b)(1)

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	N/A	EM Provider Permit Application & Renewal Form	EM Provider Permit Application & Renewal Form.docx		Yes	No	Fillable Printable

Line of Business: Natural Resources

Subfunction: Conservation, Marine and Land Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 6

Number of Respondents for Small Entity: 6

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	6	6
Annual IC Time Burden (Hours)	90	90
Annual IC Cost Burden (Dollars)	20,147	20,147

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.