Applications from Retailers

EPA's Safer Choice Partner of the Year Awards Program (Renewal)

Documents and Forms

Document Name Document Type
Form EPA Form 9600-04 Applications from Retailers Form and Instruction
EPA Form 9600-04 Safer Choice Partner of the Year Application 2450-02_AttB_form_2016-01-19.docx www2.epa.gov/sites/production/files/2015-01/documents/poty2015_application.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Applications from Retailers	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	EPA Form 9600-04	Safer Choice Partner of the Year Application	2450-02_AttB_form_2016-01-19.docx	http://www2.epa.gov/sites/production/files/2015-01/documents/poty2015_application.pdf	Yes	No	Fillable Printable

Line of Business: Environmental Management

Subfunction: Pollution Prevention and Control

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 5	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	5	-5	10
Annual IC Time Burden (Hours)	75	-75	150
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.