THIS FORM DETERMINES WHETHER AN
INDIVIDUAL WHO IS IN CONNECTION WITH A BUSINESS APPLYING FOR A
PERMIT UNDER 26 U.S.C. CHAPTERS 51 AND 52, IS QUALIFIED TO ENGAGE
IN SUCH PERMIT ACTIVITIES. IDENTIFIES THE INDIVIDUAL, RESIDENCE,
BUSINESS BACKGROUND, FINANCIAL RESOURCES FOR BUSINESS AND CRIMINAL
RECORD. IF A PERSON IS FOUND TO BE 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.