Information Collection

Representative and Address Provisions

IC 4741 under ICR 200508-0651-004 · OMB 0651-0035.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0651-0035 can be found here:

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Information Collection (IC) Details

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IC Title:	Representative and Address Provisions	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?
Form	124	Yes	Yes
Form	84	Yes	Yes
Form	81	Yes	Yes
Form	124B	Yes	Yes
Form	PTO/SB/80	Yes	Yes
Form	122	Yes	Yes
Form	83	Yes	Yes
Form	125A	Yes	Yes
Form	82	Yes	Yes
Form	123	Yes	Yes

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 370,766	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 1 %

	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	370,766	-410	16,171	355,005
Annual IC Time Burden (Hours)	23,668	167	-6,587	30,088
Annual IC Cost Burden (Dollars)	189,000	2,000	8,000	179,000

Documents for IC

Title	Document	Date Uploaded

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