Questionnaire for OMB 1140-0092 3.29.2022 W Draft Watermark

Voluntary Magazine Questionnaire For Agencies/Entities That Store Explosive Materials

Questionnaire for OMB 1140-0092 3.29.2022 W Draft Watermark

OMB: 1140-0092

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Voluntary Magazine Questionnaire for Agencies/Entities That Store Explosive Materials

Shape1

1. Name of Agency/Entity:

  1. Shape2 Address of Agency/Entity:

  2. Shape4 Shape3 Contact Name and Phone Number of Person(s) Responsible for Explosives Storage:

Shape6 Shape5 4. Mailing Address (If different from Question 2.):

  1. E-mail Address (Optional) :

6. Federal Explosives License or Permit Number(s) (If applicable):

7. Do You Lease/Own/Share Any Explosive Magazine(s)? Yes No

Shape15 Shape14 Shape11 Shape12 Shape13

8. If so, How Many? Lease Own Share Other:

(Please explain in the space below.)

9. Please Provide the Following Information About Each Magazine (Make additional copies if needed.):

Shape17 A. Magazine Type (e.g., type 1, 2, 3, 4, 5) (See Instruction 4.):

Shape18 Shape19 Magazine ID Number or Name (Number or name you use to identify the magazine.) (If applicable):

Shape20 Shape21 Magazine Location/Address (If the magazine does not have a street address, please provide driving directions from the nearest police station or post office.):


Shape22 Types of Explosives (e.g., high explosives, low explosives, blasting agents):

Shape23 Approximate Amount of Explosives Maintained in Magazine (in pounds) During a Typical 30-day Period:

Shape26 Shape25 Shape24 Purpose for Maintaining Explosives (e.g., evidence, use as bomb technician, use in roads, avalanche control, university research, or other):

Shape27 B. Magazine Type (e.g., type 1, 2, 3, 4, 5) (See Instruction 4.):

Shape28 Shape29 Magazine ID Number or Name (Number or name you use to identify the magazine.) (If applicable):

Shape30 Shape31 Magazine Location/Address (If the magazine does not have a street address, please provide driving directions from the nearest police station or post office.):


Shape32 Types of Explosives (e.g., high explosives, low explosives, blasting agents):

Shape33 Approximate Amount of Explosives Maintained in Magazine (in pounds) During a Typical 30-day Period:

Shape36 Shape35 Shape34 Purpose for Maintaining Explosives (e.g., evidence, use as bomb technician, use in roads, avalanche control, university research, or other):

Shape37 C. Magazine Type (e.g., type 1, 2, 3, 4, 5) (See Instruction 4.):

Shape38 Shape39 Magazine ID Number or Name (Number or name you use to identify the magazine.) (If applicable):

Shape40 Shape41 Magazine Location/Address (If the magazine does not have a street address, please provide driving directions from the nearest police station or post office.):


Shape42 Types of Explosives (e.g., high explosives, low explosives, blasting agents):

Shape43 Approximate Amount of Explosives Maintained in Magazine (in pounds) During a Typical 30-day Period:

Shape46 Shape45 Shape44 Purpose for Maintaining Explosives (e.g., evidence, use as bomb technician, use in roads, avalanche control, university research, or other):

Shape47 D. Magazine Type (e.g., type 1, 2, 3, 4, 5) (See Instruction 4.):

Shape48 Shape49 Magazine ID Number or Name (Number or name you use to identify the magazine.) (If applicable):

Shape50 Shape51 Magazine Location/Address (If the magazine does not have a street address, please provide driving directions from the nearest police station or post office.):


Shape52 Types of Explosives (e.g., high explosives, low explosives, blasting agents):

Shape53 Approximate Amount of Explosives Maintained in Magazine (in pounds) During a Typical 30-day Period:

Shape56 Shape55 Shape54 Purpose for Maintaining Explosives (e.g., evidence, use as bomb technician, use in roads, avalanche control, university research, or other):

PAPERWORK REDUCTION ACT NOTICE

This request is in accordance with the Paperwork Reduction Act of 1995.This information collection is used to identify the number and locations of public explosives storage facilities (magazines), which will enable the Bureau of Alcohol, Tobacco, Firearms and Explosives personnel to respond properly to local emergencies such as natural disasters. The estimated average burden associated with this collection of information is 30 minutes per respondent, depending on individual circumstances. Comments concerning the accuracy of this burden estimate and suggestions for reducing this burden should be addressed to Reports Management Officer, Resource Management Staff, Contracts and Forms Office, Bureau of Alcohol, Tobacco, Firearms and Explosives, 99 New York Ave, NE, Washington, DC 20226. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid Office of Management and Budget control number.


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