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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
CERTS Application Form	Form and Instruction
CERTS Application CERTS Application 2021-06-17 Final.docx	Form and Instruction

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:

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	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 %

table that charts list of burden
	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

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.