Information Collection

EM Service Provider - Renewal (biennial)

IC 237160 under ICR 202509-0648-003 · OMB 0648-0785.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
EM Provider Permit Application & Renewal Form EM Service Provider - Renewal (biennial) Form and Instruction
EM Provider Permit Application & Renewal Form
EMP Permit Application & Renewal Form.docx
Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

layout table

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 Yes Yes Fillable Fileable

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 6 0 0 1 0 5
Annual IC Time Burden (Hours) 18 0 0 16 0 2
Annual IC Cost Burden (Dollars) 38 0 0 6 0 32

Documents for IC
table that charts IC Documents
Title Document Date Uploaded
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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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