Information Collection

Application for Pardon Certificate

IC 256367 under ICR 202210-1123-002 · OMB 1123-0014.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1123-0014 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Application for Pardon Certificate	Form
APPLICATION FOR CERTIFICATE OF PARDON FOR SIMPLE POSSESS Certificate of Pardon Application for Simple Marijuana Possession.508 compliant.pdf www.justice.gov	Form
APPLICATION FOR CERTIFICATE OF PARDON FOR SIMPLE POSSESS Certificate of Pardon Application for Simple Marijuana Possession.508 compliant.pdf www.justice.gov	Form

IC Title:

Application for Pardon Certificate

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	NA	APPLICATION FOR CERTIFICATE OF PARDON FOR SIMPLE POSSESSION OF MARIJUANA	Certificate of Pardon Application for Simple Marijuana Possession.508 compliant.pdf	https://www.justice.gov	Yes	Yes	Fillable Fileable Signable

Line of Business: Litigation and Judicial Activities

Subfunction: Legal Prosecution and Litigation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 20,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 90 %

table that charts list of burden
	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	20,000	20,000
Annual IC Time Burden (Hours)	40,000	40,000
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.