Document
Authorized Agent Attestation
ICR 202610-0906-006 · OMB 0906-0081 · Object 174170200.
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Document Metadata
| File Type | application/pdf |
|---|---|
| File Title | Authorized Agent Attestation |
| 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 Attestation Form and Instruction
Non-visible Questions
Label
PDF Name
(step)
Why
not?
Authorized
Agent
Attestation (1)
Location
Response
Input Item
Visibility Trigger
Below the Yes Text Entry
and No radio
buttons
The field is displayed
if the user selects the
No radio button
Other
State Changes
Label
PDF Name
OMB Number:
0906-0081
Expiration Date:
mm/dd/yyyy
Authorized Modal
Agent
Attestation
Item Type
Trigger
When the user selects the link the
modal is displayed with the public
burden statement content.