Information Collection

Certification of Qualifying State Relief From Disabilities Program

IC 188936 under ICR 201301-1140-005 · OMB 1140-0094.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1140-0094 can be found here:

Documents and Forms

Document Name Document Type
Form ATF F 3210.12 Certification of Qualifying State Relief From Disabilities Program Form and Instruction
ATF F 3210.12 Certification of Qualifying State Relief from Disabiliti F321012 (November 2012).pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Certification of Qualifying State Relief From Disabilities Program	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 27 CFR 478.11

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	ATF F 3210.12	Certification of Qualifying State Relief from Disabilities Program	F321012 (November 2012).pdf		Yes	No	Fillable Printable

Line of Business: Law Enforcement

Subfunction: Crime Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 50	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	13	13
Annual IC Cost Burden (Dollars)	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.