Electronic Collect Electronic Collection Instrument

Attachment 3

Page 11 of 11

Login Screen:

Burden Statement:

Main Menu (Dashboard) Screen:

Mailing Address Screen:

Physical Location Screen A

Physical Location Screen B

[Physical Location Screen A] = No

Physical Location Screen C:

Principal Business or Activity (depending on RECORD_NAICS value)

(RECORD_NAICS begins with ‘42’)

Type of Operation

(RECORD_NAICS begins with ‘42’)

Class of Customer A

RECORD_NAICS begins with ‘42’, ‘44’, or ‘45’

Class of Customer B

[Class of Customer A] = Yes

Class of Customer C

[Class of Customer A] = No

Class of Customer D

Remarks Certification Screen B

Review

Submission Confirmation

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