SOUTHEAST REGION EXIT QUESTIONNAIRE

ICR 198110-1545-006

OMB: 1545-0576

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
130148 Migrated
ICR Details
1545-0576 198110-1545-006
Historical Active
TREAS/IRS
SOUTHEAST REGION EXIT QUESTIONNAIRE
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 11/11/1981
Retrieve Notice of Action (NOA) 10/08/1981
This request for clearance is approved for use through 6-30-82. Consider using a National or OPM Standard Form for the collection of the information required. For extension or revision of this approval, the Department must provide OMB a detailed description of purpose and use of each data element. Also identify all items that are not entered into the computer and explain the consequence of not collecting these items.
  Inventory as of this Action Requested Previously Approved
06/30/1982 06/30/1982
1,500 0 0
250 0 0
0 0 0

THIS FORM IS USED TO IDENTIFY UNFAVORABLE PRACTICES AND/OR TRENDS THAT MAY CAUSE COMPETENT EMPLOYEES TO LEAVE THE INTERNAL REVENUE SERVICE AN TO IDENTIFY NECESSITY FOR CORRECTIVE ACTION.

None
None


No

1
IC Title Form No. Form Name
SOUTHEAST REGION EXIT QUESTIONNAIRE 500-5-435

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 1,500 0 0 0 1,500 0
Annual Time Burden (Hours) 250 0 0 0 250 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

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.
10/08/1981


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