The approved
expiration date need not be printed on the form.
Inventory as of this Action
Requested
Previously Approved
10/31/1985
10/31/1985
3,000
0
0
1,500
0
0
0
0
0
WHEN AN APPLICANT FOR A LICENSE OR
PERMIT HAS BEEN CHARGED WITH A VIOLATION OF FEDERAL OR STATE LAW
AND THERE IS NO RECORDS OF THE DISPOSITION OF THE CASE, THIS FORM
IS SENT TO THE CUSTODIAN OF THE RECORDS TO ASCERTAIN THE
DISPOSITION. THE INFORMATION IS NEEDED TO DETERMINE IF THE
APPLICANT IS ELIGIBLE TO RECEIVE THE LICENSE OR PERMIT.
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.