SAMPLE AGENCY DISCLOSURE NOTICE - DIRECTIONS
All information collection instruments (forms, questionnaires, web-based instruments, etc.) must contain an "Agency Disclosure Notice" (ADN) which should be prominently displayed at the top or beginning of the collection instrument. Please complete the highlighted sections below. The bolded, highlighted text serves as placeholders which the actual information will replace.
OMB CONTROL NUMBER: 0702-0125
OMB EXPIRATION DATE: XX/XX/XXXX
AGENCY DISCLOSURE NOTICE
The public reporting burden for this collection of information is estimated to average two minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, Executive Services Directorate, Directives Division, 4800 Mark Center Drive, East Tower, Suite 03F09, Alexandria, VA 22350-3100 OMB Control Number 0702-0125. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number.
PLEASE DO NOT RETURN YOUR RESPONSE TO THE ABOVE ADDRESS.
Responses should be sent to Office of the Product, Manager for Force Protection Systems
(PdM–FPS), 5900 Putnam Road, Building 365/Suite 1, (SFAE–IEW–TF), ATTN: Mark Shuler, Fort Belvoir, VA 22060–5420.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Title | 0702-0125 Agency Disclosure Notice |
| Author | Patricia Toppings |
| File Modified | 0000-00-00 |
| File Created | 2021-01-14 |