Fastener Quality Act Requirements

Attachment 4
Information Declaration to be completed by Petitioners
OMB Number: 0693-0015
Approval Expires:
U.S. DEPARTMENT OF COMMERCE
NATIONAL INSTITUTE OF STANDARDS AND TECHNOLOGY
FASTENER QUALITY ACT
Notwithstanding any other provision of the Act, no person is required to respond to, nor shall any person
be subject to a penalty for failure to comply with, a collection-of-information subject to the requirements
of the Paperwork Reduction Act, unless that collection of information displays a currently valid Office of
Management and Budget (OMB) Control Number.
The reason for collecting this information is to seek information from persons petitioning the Director of
NIST to approve use of an alternative document published by the petitioner setting forth guidance or
requirements providing equal or greater rigor and reliability compared to ISO/IEC 17025, ISO/IEC 17011,
or ISO/IEC Guide 62. If the Director approves the document an organization may use the document as an
alternative to the respective ISO/IEC document. No confidentiality for the information submitted is
promised or provided.
The public reporting burden per respondent for the collection of information contained in this rule is
estimated to average 20 hours. This estimate includes the time for reviewing instructions, searching
existing information, gathering and maintaining the information needed, and completing and reviewing
the collection of information. Send comments regarding this burden estimate or any other aspect of this
collection of information, including suggestions for reducing this burden to Office of Information and
Regulatory Affairs, Office of Management and Budget, Washington, D.C. 20503; and to National
Institute of Standards and Technology, 100 Bureau Dr. Mail Stop 2600, Gaithersburg, MD 20899-2600.
This information can be placed on the information declaration, in the instructions for a collection, or in a
cover letter or memo that accompanies the collection of information. We usually recommend the
information declaration itself but you may feel otherwise.

INFORMATION DECLARATION INSTRUCTIONS

1.

Print or type all information. If more space is needed for a response use additional
sheets and reference the question being answered.

2.

Respond to all applicable questions fully. If not applicable write N/A.

3.

Any provided information that is considered proprietary or confidential should be clearly
indicated as such.

4.

All information must be completed in English.

5.

Send all completed information declarations to:
FQA Document Certification
National Institute of Standards and Technology
100 Bureau Drive, Mail Stop 2600
Gaithersburg, MD 20899-2600

For assistance call 301-975-4011 or Fax 301-926-0647

OMB Number: 0693-0015
Approval Expires: 8/31/2006
INFORMATION DECLARATION
FOR A PETITIONER
UNDER THE FASTENER QUALITY ACT
1.

Legal Name of Petitioner Organization:

2.

Authorized Representative:
The Authorized Representative is the person who assumes all responsibility to commit the
organization to the terms of the agreement with NIST. This person will be NIST’s point of
contact with the organization. All correspondence with the organization will be addressed
to this person.
Printed Name
Title
Address
Street
(Mailstop, P.O.)
City

State

Zip

Country
Telephone
E-Mail

FAX

Petition

As the Authorized Representative of the organization, I hereby petition the Director of NIST to
approve the attached document published by this organization.

Document Title
Date of Publication
I assert that the document provides equal or greater rigor and reliability as compared to:
Provide designation of ISO/IEC Document
Please attach a comparison indicating the correspondence between clauses of the ISO/IEC Document
and the document submitted for approval.
I will ensure that the organization does not state or imply in any way that NIST endorses the
document beyond the approval for use in the context of the Fastener Quality Act as an
alternative to the respective ISO/IEC Document.
Authorized Representative:

Signature

Title

Date