Additional Documentation and Certification

Countermeasures Injury Compensation Program (CICP)

OMB: 0915-0334

IC ID: 208417

Documents and Forms
Document Name
Document Type
Form
Form
Form
Form
Form
Form
Form
Form
Information Collection (IC) Details

View Information Collection (IC)

Additional Documentation and Certification
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 3 Certification Form 03142023 - Certification Form.docx Yes Yes Fillable Fileable
Form 1 Certification Form - Clean 10162023 - (20) Certification Form - CLEAN.docx Yes Yes Fillable Fileable
Form 1 Certification Form - Redline 10162023 - (20) Certification Form - REDLINE.docx Yes Yes Fillable Fileable

Health Consumer Health and Safety

CICP System of Records Notice  84 FR 28829

30 0
   
Individuals or Households
 
   80 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 30 0 0 0 0 30
Annual IC Time Burden (Hours) 23 0 0 0 0 23
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.
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