This request for
clearance is approved for use through November 30, 1982, because
its purpose is regulatory or compliance. For extension or revision
of this approval provide data on actual use and planned future use.
What would be the consequence of discontinuing requirements in
terms of Federal need.
Inventory as of this Action
Requested
Previously Approved
02/28/1983
02/28/1983
12/31/1981
5,000
0
5,000
10,000
0
10,000
0
0
0
FORM DETERMINES WHETHER AN INDIVIDUAL
WHO IS OR IN CONNECTION WITH A BUSINESS APPLYING FOR A PERMIT ORDER
26 U.S.C. CHAPTERS 51 AND 52 HIS QUALIFICATION TO ENGAGE IN SUCH
PERMIT ACTIVITIES. IDENTIFIES THE INDIVIDUAL, HIS RESIDENCE
BUSINESS BACKGROUND, FINANCIAL SOURCES FOR BUSINESS, AND CRIMINAL
RECORD. IF SUCH PERSON IS NOT QUALIFIED, THE PERMIT MAY BE DENIED
OR ANNULLED.
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.