Virginia Graeme Baker Pool and Spa Safety Act Verification of Compliance Form

OMB 3041-0142

CPSC staff will fill in the form during the course of a pool and spa inspection to determine if the swimming pool and spa drain cover meets the requirements of ANSI/APSP 16 2017.

The latest form for Virginia Graeme Baker Pool and Spa Safety Act Verification of Compliance Form expires 2022-11-30 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form CPSC 120 Virginia Graeme Baker Pool and Spa Safety Act Verification of Compliance Form Form
30DayNotice_87FR65194_28October2022.pdf Supplementary Document
60DayNotice_87FR50612_17August2022.pdf Supplementary Document
PoolSpaDrainSafetyCover_Supporting_Statement_2022.docx Supporting Statement A
Memo_Update of Compliance Form for VGBA Inspections - Non-Substantive Change.pdf Justification for No Material/Nonsubstantive Change
Virginia Graeme Baker Pool and Spa Safety Act Verification of Compliance Form Form

202211-3041-003 Approved without change	Extension without change of a currently approved collection	2022-11-14
202110-3041-001 Approved without change	No material or nonsubstantive change to a currently approved collection	2021-10-25
201909-3041-001 Approved without change	Extension without change of a currently approved collection	2019-09-05
201607-3041-001 Approved without change	Revision of a currently approved collection	2016-07-22
201304-3041-003 Approved without change	Revision of a currently approved collection	2013-07-10
201108-3041-001 Approved without change	No material or nonsubstantive change to a currently approved collection	2011-09-06
200912-3041-001 Approved without change	Existing collection in use without an OMB Control Number	2010-05-28