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pdfSAMPLE AGENCY DISCLOSURE NOTICE - DIRECTIONS
All information collection instruments (forms, questionnaires, web-based instruments,
etc.) must contain an "Agency Disclosure Notice" (ADN) which should be prominently
displayed at the top or beginning of the collection instrument. Please complete the
highlighted sections below. The bolded, highlighted text serves as placeholders which the
actual information will replace.
OMB CONTROL NUMBER: 0704-0570
OMB EXPIRATION DATE: XX/XX/XXXX
AGENCY DISCLOSURE NOTICE
The public reporting burden for this collection of information, 0704-0570 is estimated to
average 0.33 hours per response, including the time for reviewing instructions, searching
existing data sources, gathering and maintaining the data needed, and completing and
reviewing the collection of information. Send comments regarding the burden estimate or
burden reduction suggestions to the Department of Defense, Washington Headquarters
Services, at [email protected].
Respondents should be aware that notwithstanding any other provision of law, no person
shall be subject to any penalty for failing to comply with a collection of information if it
does not display a currently valid OMB control number.
Version 1.1 – Effective 7/18/2017
| File Type | application/pdf |
| File Title | The following is a sample Agency Disclosure Notice: |
| Author | Patricia Toppings |
| File Modified | 2023-09-25 |
| File Created | 2023-09-25 |