Information Collection

Virginia Graeme Baker Pool and Spa Safety Act Verification of Compliance Form

IC 191497 under ICR 202211-3041-003 · OMB 3041-0142.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3041-0142 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CPSC 120 Virginia Graeme Baker Pool and Spa Safety Act Verification of Compliance Form	Form
Form CPSC 120 Compliance Verification Form Virginia Graeme Baker Pool and Spa Safety Act Verification of Compliance Form	Form
Form CPSC 120 Compliance Verification Form Virginia Graeme Baker Pool and Spa Safety Act Verification of Compliance Form	Form
CPSC 120 Compliance Verification Form FINAL VGBA Checklist - REVISED-8-24-11-OMB -3041-0142 (2).doc	Form
CPSC 120 Compliance Verification Form FINAL VGBA Checklist - REVISED-8-24-11-OMB -3041-0142 (2).doc	Form
CPSC 120 Compliance Verification Form VGBA Checklist - REVISED-OMB -3041-0142.docx	Form
CPSC 120 Compliance Verification Form VGBA Checklist - REVISED-OMB -3041-0142.docx	Form

IC Title:

Virginia Graeme Baker Pool and Spa Safety Act Verification of Compliance Form

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

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	CPSC 120				No		Paper Only
Form	CPSC 120				No		Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 50

Number of Respondents for Small Entity: 50

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	50	-50	100
Annual IC Time Burden (Hours)	150	-150	300
Annual IC Cost Burden (Dollars)	0	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.

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