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Authorized Agent Designation
ICR 202610-0906-006 · OMB 0906-0081 · Object 174169600.
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Document Metadata
| File Type | application/pdf |
|---|---|
| File Title | Authorized Agent Designation |
| Author | Jo Anne Wright |
| Last Modified By | Adobe Acrobat (64-bit) 26.1.21431 |
| File Modified | 2026-06-29 |
| File Created | 2026-04-27 |
| Conversion State | complete |
Extracted Text
Authorized Agent Designation Form and Instruction State Changes Label PDF Name OMB Number: 0906-0081 Expiration Date: mm/dd/yyyy Authorized Agent Designation Modal When the user selects the link the modal is displayed with the public burden statement content. I authorize my agent to resolve compliance actions on our behalf for professions in a compliance review Authorized Agent Designation Checkbox This is only displayed if the entity type qualifies for a compliance review. Item Type Trigger