Information Collection

Application for Certificate of Pardon for Simple Possession of Marijuana

IC 258401 under ICR 202302-1123-003 · 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⚠️ Notice: This information collection may be referencing outdated material.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 Certificate of Pardon for Simple Possession of Marijuana	Form and Instruction
Application for Certificate of Pardon for Simple Possession of Marijuana	Form and Instruction
APPLICATION FOR CERTIFICATE OF PARDON FOR SIMPLE POSSESS Application for Certificate of Pardon for Simple Marijuana Possession.docx www.justice.gov	Form and Instruction
APPLICATION FOR CERTIFICATE OF PARDON FOR SIMPLE POSSESS Application for Certificate of Pardon for Simple Marijuana Possession.docx www.justice.gov	Form and Instruction

IC Title:

Application for Certificate of Pardon for Simple Possession of Marijuana

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	APPLICATION FOR CERTIFICATE OF PARDON FOR SIMPLE POSSESSION OF MARIJUANA	Application for Certificate of Pardon for Simple Marijuana Possession.docx	https://www.justice.gov	Yes	Yes	Fillable Printable

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	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	20,000	0	20,000
Annual IC Time Burden (Hours)	0	40,000	-40,000
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.