This request for
clearance is approved for use though September 30, 1982. In
requesting an extension provide a description of the methods used
to verify each piece of information received on this form which
would adversely impact upon the applicant. Also explain the
confidentiality of the information recieved in light of the Freedom
of Information Act and the Privacy Act.
Inventory as of this Action
Requested
Previously Approved
12/31/1982
12/31/1982
12/31/1981
1,500
0
1,500
1,500
0
1,500
0
0
0
FORM IS USED TO CHECK REFERENCES GIVEN
BY AN APPLICANT OR AN INDIVIDUAL CONNECTED WITH A PPLICATION FOR A
FEDERAL LICENSE OR PERMIT. ASKS THE REFERENCE TO GIVEN INFORMATION
(LENGTH OF ASSOCIATION, CHARACTER, INTEGRITY, BUSINESS
RESPONSIBILITY AND GENERAL REPUTATION FOR CONFORMING WITH LAWS AND
REGULATIONS) ABOUT THE INDIVIDUAL. PROVIDES EVIDENCE AS TO WHETHER
LICENSE OR PERMIT SHOULD BE ISSUED.
On behalf of this Federal agency, I certify that
the collection of information encompassed by this request complies
with 5 CFR 1320.9 and the related provisions of 5 CFR
1320.8(b)(3).
The following is a summary of the topics, regarding
the proposed collection of information, that the certification
covers:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a
benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control
number;
If you are unable to certify compliance with any of
these provisions, identify the item by leaving the box unchecked
and explain the reason in the Supporting Statement.