SAMPLE AGENCY DISCLOSURE NOTICE - DIRECTIONS
All information collection instruments (forms, questionnaires, web-based instruments, etc.) must contain an "Agency Disclosure Notice" (ADN) which should be prominently displayed at the top or beginning of the collection instrument. Please complete the highlighted sections below. The bolded, highlighted text serves as placeholders which the actual information will replace.
OMB CONTROL NUMBER: XXXX-XXXX
OMB EXPIRATION DATE: XX/XX/XXXX
AGENCY DISCLOSURE NOTICE
The public reporting burden for this collection of information, [Insert OMB Control Number], is estimated to average 15 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or burden reduction suggestions to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-information-collections@mail.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number.
Version 1.1 – Effective 7/18/2017
| File Type | application/msword |
| File Title | ADN |
| Author | Patricia Toppings |
| Last Modified By | SYSTEM |
| File Modified | 2017-12-01 |
| File Created | 2017-12-01 |