Information Collection

CERTS Application Form

IC 247965 under ICR 202106-1505-003 · OMB 1505-0273.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1505-0273 can be found here:

Documents and Forms

Document Name Document Type
CERTS Application Form Form and Instruction
CERTS Application CERTS Application 2021-06-17 Final.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	CERTS Application Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	N/A	CERTS Application	CERTS Application 2021-06-17 Final.docx		Yes	Yes	Fillable Fileable Signable

Line of Business: Economic Development

Subfunction: Industry Sector Income Stabilization

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 8,000	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	8,000	8,000
Annual IC Time Burden (Hours)	16,000	16,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.