Information Collection Request

Representative and Address Provisions

ICR 202507-0651-006 · OMB 0651-0035 · Active

Forms and Documents
DocumentTypeStatusAvailability
Form PTO/AIA/80 Power of Attorney to Prosecute Applications Before the USPTO Form Modified Available
Form PTO/SB/80 Power of Attorney to Prosecute Applications Before the USPTO Form Modified Available
Form PTO/SB/80 Power of Attorney to Prosecute Applications Before the USPTO Form Modified Missing upstream
Form PTO-2248 Request to Update a PCT Application with a Customer Number Form Removed Available
Form PTO-2248 Request to Update a PCT Application with a Customer Number (Individuals or Households) Form Removed Repair queued
Form PTO-2248 Request to Update a PCT Application with a Customer Number Form Modified Available
Form PTO-2248 Request to Update a PCT Application with a Customer Number Form Modified Missing upstream
Form PTO/SB/125 Request for Customer Number Form Removed Repair queued
Form PTO/SB/125 Request for Customer Number (Individuals or Households) Form Removed Missing upstream
Form PTO/SB/125 Request for Customer Number Form Modified Available
Form PTO/SB/125 Request for Customer Number Form Modified Repair queued
Form PTO/SB/124 Request for Customer Number Data Change Form Removed Available
Form PTO/SB/124 Request for Customer Number Data Change (Individuals or Households) Form Removed Repair queued
Form PTO/SB/124 Request for Customer Number Data Change Form Modified Available
Form PTO/SB/124 Request for Customer Number Data Change Form Modified Repair queued
Form PTO/SB/83 Request for Withdrawal as Attorney or Agent and Change of Correspondence Address Form Removed Available
Form PTO/AIA/83 Request for Withdrawal as Attorney or Agent and Change of Correspondence Address Form Removed Available
Form PTO/AIA/83 Request for Withdrawal as Attorney or Agent and Change of Correspondence Address (Individuals or Households) Form Removed Repair queued
Form PTO/SB/83 Request for Withdrawal as Attorney or Agent and Change of Correspondence Address Form Modified Available
Form PTO/AIA/83 Request for Withdrawal as Attorney or Agent and Change of Correspondence Address Form Modified Available
Form PTO/AIA/83 Request for Withdrawal as Attorney or Agent and Change of Correspondence Address Form Modified Repair queued
Form PTO/SB/81C Reexamination – Third Party Requester Power of Attorney or Revocation of Power of Attorney with a New Power of Attorney and Change of Correspondence Address Form Removed Available
Form PTO/SB/81C Reexamination – Third Party Requester Power of Attorney or Revocation of Power of Attorney with a New Power of Attorney and Change of Correspondence Address (Individuals or Households) Form Removed Repair queued
Form PTO/SB/81C Reexamination – Third Party Requester Power of Attorney or Revocation of Power of Attorney with a New Power of Attorney and Change of Correspondence Address Form Modified Available
Form PTO/SB/81C Reexamination – Third Party Requester Power of Attorney or Revocation of Power of Attorney with a New Power of Attorney and Change of Correspondence Address Form Modified Repair queued
Form PTO/SB/81B Reexamination – Patent Owner Power of Attorney or Revocation of Power of Attorney with a New Power of Attorney and Change of Correspondence Address Form Removed Available
Form PTO/AIA/81B Reexamination – Patent Owner Power of Attorney or Revocation of Power of Attorney with a New Power of Attorney and Change of Correspondence Address Form Removed Available
Form PTO/AIA/81B Reexamination – Patent Owner Power of Attorney or Revocation of Power of Attorney with a New Power of Attorney and Change of Correspondence Address (Individuals or Households) Form Removed Missing upstream
Form PTO/SB/81B Reexamination – Patent Owner Power of Attorney or Revocation of Power of Attorney with a New Power of Attorney and Change of Correspondence Address Form Modified Available
Form PTO/AIA/81B Reexamination – Patent Owner Power of Attorney or Revocation of Power of Attorney with a New Power of Attorney and Change of Correspondence Address Form Modified Available
Form PTO/AIA/81B Reexamination – Patent Owner Power of Attorney or Revocation of Power of Attorney with a New Power of Attorney and Change of Correspondence Address Form Modified Missing upstream
Form PTO/SB/81A Patent – Power of Attorney or Revocation of Power of Attorney with a New Power of Attorney and Change of Correspondence Address Form Removed Available
Form PTO/AIA/81A Patent – Power of Attorney or Revocation of Power of Attorney with a New Power of Attorney and Change of Correspondence Address Form Removed Available
Form PTO/SB/81 Patent – Power of Attorney or Revocation of Power of Attorney with a New Power of Attorney and Change of Correspondence Address Form Removed Available
Form PTO/AIA/81 Power of Attorney to One or More of The Joint Inventors and Change of Correspondence Address Form Removed Available
Form PTO/AIA/81 Patent – Power of Attorney or Revocation of Power of Attorney with a New Power of Attorney and Change of Correspondence Address (Individuals or Households) Form Removed Repair queued
Form PTO/SB/81A Patent – Power of Attorney or Revocation of Power of Attorney with a New Power of Attorney and Change of Correspondence Address Form Modified Available
Form PTO/AIA/81A Power of Attorney or Revocation of Power of Attorney with a New Power of Attorney and Change of Correspondence Address Form Modified Available
Form PTO/SB/81 Power of Attorney or Revocation of Power of Attorney with a New Power of Attorney and Change of Correspondence Address Form Modified Available
Form PTO/AIA/81 Power of Attorney to One or More of The Joint Inventors and Change of Correspondence Address Form Modified Available
Form PTO/AIA/81 Patent – Power of Attorney or Revocation of Power of Attorney with a New Power of Attorney and Change of Correspondence Address Form Modified Repair queued
Form PTO/AIA/82A/B/C Transmittal for Power of Attorney to One or More Registered Practitioners/Power of Attorney by Applicant Form Removed Available
Form PTO/AIA/82A/B/C Power of Attorney or Revocation of Power of Attorney with a New Power of Attorney and Change of Correspondence (Individuals or Households) Form Removed Repair queued
Form PTO/AIA/82A/B/C Transmittal for Power of Attorney to One or More Registered Practitioners/Power of Attorney by Applicant Form Modified Available
Form PTO/AIA/82A/B/C Power of Attorney or Revocation of Power of Attorney with a New Power of Attorney and Change of Correspondence Form Modified Repair queued
Form PTO/AIA/80 Power of Attorney to Prosecute Applications Before the USPTO Form Removed Available
Form PTO/SB/80 Power of Attorney to Prosecute Applications Before the USPTO Form Removed Repair queued
Form PTO/SB/80 Power of Attorney to Prosecute Applications Before the USPTO (Individuals or Households) Form Removed Repair queued
0651-0035 Supporting Statement 2025_final (1).docx Supporting Statement A Uploaded 2025-09-15 Repair queued
0651-0035 Supporting Statement 2025_final (1).docx Supporting Statement A Uploaded 2025-09-15 Repair queued
USPTO Information Quality Guidelines.pdf Supplementary Document Uploaded 2025-07-24 Available
USPTO Information Quality Guidelines.pdf Supplementary Document Uploaded 2025-07-24 Missing upstream
Leahy-Smith America Invents Act.pdf Supplementary Document Uploaded 2025-07-24 Repair queued
Leahy-Smith America Invents Act.pdf Supplementary Document Uploaded 2025-07-24 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
4741 Power of Attorney to Prosecute Applications Before the USPTO Form ModifiedPower of Attorney to Prosecute Applications Before the USPTO
4741 Power of Attorney to Prosecute Applications Before the USPTO Form ModifiedPower of Attorney to Prosecute Applications Before the USPTO
4741 Power of Attorney to Prosecute Applications Before the USPTO Form Modified
246147 Request to Update a PCT Application with a Customer Number (Individuals or Households) Form RemovedRequest to Update a PCT Application with a Customer Number
246147 Request to Update a PCT Application with a Customer Number (Individuals or Households) Form Removed
246146 Request to Update a PCT Application with a Customer Number Form ModifiedRequest to Update a PCT Application with a Customer Number
246146 Request to Update a PCT Application with a Customer Number Form Modified
246145 Customer Number Upload Spreadsheet (Individuals or Households) Removed
246144 Customer Number Upload Spreadsheet Modified
246143 Request for Customer Number (Individuals or Households) Form RemovedRequest for Customer Number
246143 Request for Customer Number (Individuals or Households) Form Removed
246142 Request for Customer Number Form ModifiedRequest for Customer Number
246142 Request for Customer Number Form Modified
187264 Request for Customer Number Data Change (Individuals or Households) Form RemovedRequest for Customer Number Data Change
187264 Request for Customer Number Data Change (Individuals or Households) Form Removed
187263 Request for Customer Number Data Change Form ModifiedRequest for Customer Number Data Change
187263 Request for Customer Number Data Change Form Modified
187262 Petition to Waive 37 CFR 1.32(b)(4) and Grant Power of Attorney by Fewer than All the Applicants Modified
187260 Petition Under 37 CFR 1.36(a) to Revoke Power of Attorney by Fewer than All the Applicants Modified
187259 Request for Withdrawal as Attorney or Agent and Change of Correspondence Address (Individuals or Households) Form RemovedRequest for Withdrawal as Attorney or Agent and Change of Correspondence Address
187259 Request for Withdrawal as Attorney or Agent and Change of Correspondence Address (Individuals or Households) Form RemovedRequest for Withdrawal as Attorney or Agent and Change of Correspondence Address
187259 Request for Withdrawal as Attorney or Agent and Change of Correspondence Address (Individuals or Households) Form Removed
186503 Request for Withdrawal as Attorney or Agent and Change of Correspondence Address Form ModifiedRequest for Withdrawal as Attorney or Agent and Change of Correspondence Address
186503 Request for Withdrawal as Attorney or Agent and Change of Correspondence Address Form ModifiedRequest for Withdrawal as Attorney or Agent and Change of Correspondence Address
186503 Request for Withdrawal as Attorney or Agent and Change of Correspondence Address Form Modified
186502 Reexamination – Third Party Requester Power of Attorney or Revocation of Power of Attorney with a New Power of Attorney and Change of Correspondence Address (Individuals or Households) Form RemovedReexamination – Third Party Requester Power of Attorney or Revocation of Power of Attorney with a New Power of Attorney and Change of Correspondence Address
186502 Reexamination – Third Party Requester Power of Attorney or Revocation of Power of Attorney with a New Power of Attorney and Change of Correspondence Address (Individuals or Households) Form Removed
186501 Reexamination – Third Party Requester Power of Attorney or Revocation of Power of Attorney with a New Power of Attorney and Change of Correspondence Address Form ModifiedReexamination – Third Party Requester Power of Attorney or Revocation of Power of Attorney with a New Power of Attorney and Change of Correspondence Address
186501 Reexamination – Third Party Requester Power of Attorney or Revocation of Power of Attorney with a New Power of Attorney and Change of Correspondence Address Form Modified
186500 Reexamination – Patent Owner Power of Attorney or Revocation of Power of Attorney with a New Power of Attorney and Change of Correspondence Address (Individuals or Households) Form RemovedReexamination – Patent Owner Power of Attorney or Revocation of Power of Attorney with a New Power of Attorney and Change of Correspondence Address
186500 Reexamination – Patent Owner Power of Attorney or Revocation of Power of Attorney with a New Power of Attorney and Change of Correspondence Address (Individuals or Households) Form RemovedReexamination – Patent Owner Power of Attorney or Revocation of Power of Attorney with a New Power of Attorney and Change of Correspondence Address
186500 Reexamination – Patent Owner Power of Attorney or Revocation of Power of Attorney with a New Power of Attorney and Change of Correspondence Address (Individuals or Households) Form Removed
186499 Reexamination – Patent Owner Power of Attorney or Revocation of Power of Attorney with a New Power of Attorney and Change of Correspondence Address Form ModifiedReexamination – Patent Owner Power of Attorney or Revocation of Power of Attorney with a New Power of Attorney and Change of Correspondence Address
186499 Reexamination – Patent Owner Power of Attorney or Revocation of Power of Attorney with a New Power of Attorney and Change of Correspondence Address Form ModifiedReexamination – Patent Owner Power of Attorney or Revocation of Power of Attorney with a New Power of Attorney and Change of Correspondence Address
186499 Reexamination – Patent Owner Power of Attorney or Revocation of Power of Attorney with a New Power of Attorney and Change of Correspondence Address Form Modified
186498 Patent – Power of Attorney or Revocation of Power of Attorney with a New Power of Attorney and Change of Correspondence Address (Individuals or Households) Form RemovedPatent – Power of Attorney or Revocation of Power of Attorney with a New Power of Attorney and Change of Correspondence Address
186498 Patent – Power of Attorney or Revocation of Power of Attorney with a New Power of Attorney and Change of Correspondence Address (Individuals or Households) Form RemovedPatent – Power of Attorney or Revocation of Power of Attorney with a New Power of Attorney and Change of Correspondence Address
186498 Patent – Power of Attorney or Revocation of Power of Attorney with a New Power of Attorney and Change of Correspondence Address (Individuals or Households) Form RemovedPatent – Power of Attorney or Revocation of Power of Attorney with a New Power of Attorney and Change of Correspondence Address
186498 Patent – Power of Attorney or Revocation of Power of Attorney with a New Power of Attorney and Change of Correspondence Address (Individuals or Households) Form RemovedPower of Attorney to One or More of The Joint Inventors and Change of Correspondence Address
186498 Patent – Power of Attorney or Revocation of Power of Attorney with a New Power of Attorney and Change of Correspondence Address (Individuals or Households) Form Removed
186497 Patent – Power of Attorney or Revocation of Power of Attorney with a New Power of Attorney and Change of Correspondence Address Form ModifiedPatent – Power of Attorney or Revocation of Power of Attorney with a New Power of Attorney and Change of Correspondence Address
186497 Patent – Power of Attorney or Revocation of Power of Attorney with a New Power of Attorney and Change of Correspondence Address Form ModifiedPower of Attorney or Revocation of Power of Attorney with a New Power of Attorney and Change of Correspondence Address
186497 Patent – Power of Attorney or Revocation of Power of Attorney with a New Power of Attorney and Change of Correspondence Address Form ModifiedPower of Attorney or Revocation of Power of Attorney with a New Power of Attorney and Change of Correspondence Address
186497 Patent – Power of Attorney or Revocation of Power of Attorney with a New Power of Attorney and Change of Correspondence Address Form ModifiedPower of Attorney to One or More of The Joint Inventors and Change of Correspondence Address
186497 Patent – Power of Attorney or Revocation of Power of Attorney with a New Power of Attorney and Change of Correspondence Address Form Modified
186496 Power of Attorney or Revocation of Power of Attorney with a New Power of Attorney and Change of Correspondence (Individuals or Households) Form RemovedTransmittal for Power of Attorney to One or More Registered Practitioners/Power of Attorney by Applicant
186496 Power of Attorney or Revocation of Power of Attorney with a New Power of Attorney and Change of Correspondence (Individuals or Households) Form Removed
186495 Power of Attorney or Revocation of Power of Attorney with a New Power of Attorney and Change of Correspondence Form ModifiedTransmittal for Power of Attorney to One or More Registered Practitioners/Power of Attorney by Applicant
186495 Power of Attorney or Revocation of Power of Attorney with a New Power of Attorney and Change of Correspondence Form Modified
178322 Power of Attorney to Prosecute Applications Before the USPTO (Individuals or Households) Form RemovedPower of Attorney to Prosecute Applications Before the USPTO
178322 Power of Attorney to Prosecute Applications Before the USPTO (Individuals or Households) Form RemovedPower of Attorney to Prosecute Applications Before the USPTO
178322 Power of Attorney to Prosecute Applications Before the USPTO (Individuals or Households) Form Removed
ICR Details
0651-0035 202507-0651-006
Active 202410-0651-013
DOC/PTO
Representative and Address Provisions
Revision of a currently approved collection   No
Regular
Approved without change 11/28/2025
Retrieve Notice of Action (NOA) 09/15/2025
  Inventory as of this Action Requested Previously Approved
11/30/2028 36 Months From Approved 11/30/2025
182,085 0 226,573
88,922 0 111,104
24,698 0 25,855

This information collection includes the information necessary to submit a request to grant or revoke power of attorney for an application, patent, or reexamination proceeding, and for a registered practitioner to withdraw as attorney or agent of record. This also includes the information necessary to change the correspondence address for an application, patent, or reexamination proceeding, to request a Customer Number and manage the correspondence address and list of practitioners associated with a Customer Number, and to designate or change the correspondence address or fee address for one or more patents or applications by using a Customer Number. Under 35 U.S.C. 2 and 37 CFR 1.31-1.32, power of attorney may be granted to one or more joint inventors or a person who is registered to practice before the USPTO to act in an application or a patent. In particular, for an application filed before September 16, 2012, or for a patent which issued from an application filed before September 16, 2012, power of attorney may be granted by the applicant for patent (as set forth in 37 CFR 1.41(b) (pre-AIA)) or the assignee of the entire interest of the applicant. For an application filed on or after September 16, 2012, or for a patent which issued from an application filed on or after September 16, 2012, power of attorney may be granted by the applicant for patent (as set forth in 37 CFR 1.42) or the patent owner. The USPTO provides two different versions of the most forms for establishing power of attorney based upon whether the application filing date iswas filed before or after September 16, 2012 or was filed on or after September 16, 2012. Providing forms based upon whether the application was filed before September 16, 2012 or was filed on or after September 16, 2012 reduces applicants’ burden in having to determine the appropriate power of attorney requirements for a given application. , to thereby reduce applicants’ burden in having to determine the appropriate power of attorney requirements for a given application. 37 CFR 1.36 provides for the revocation of a power of attorney at any stage in the proceedings of a case. 37 CFR 1.36 also provides a path by which a registered patent attorney or patent agent who has been given a power of attorney may withdraw as attorney or agent of record. A Customer Number is a unique number created by the USPTO and is used instead of a physical address. The Customer Number allows a group of filings to be associated with a single correspondence mailing address. The USPTO’s Customer Number practice permits applicants, patent owners, assignees, and practitioners of record, or the representatives of record for a number of applications or patents, to change the correspondence address of a patent application or patent with one change request instead of filing separate requests for each patent or application. Any changes to the address or practitioner information associated with a Customer Number will be applied to all patents and applications associated with said Customer Number. Changes of correspondence address or power of attorney may be filed separately for each patent or application without using a Customer Number. However, a valid Customer Number provides secure access to patent information through the registered USPTO.gov account using the USPTO patent electronic filing system (Patent Center), which is available through the USPTO website. Additionally, the use of a Customer Number is also required in order to grant power of attorney to more than ten practitioners or to establish a separate “fee address” for maintenance fee purposes that is different from the correspondence address for a patent or application.

PL: Pub.L. 112 - 29 1 Name of Law: Leahy-Smith America Invents Act
  
None

Not associated with rulemaking

  90 FR 21760 05/21/2025
90 FR 44372 09/15/2025
No

12
IC Title Form No. Form Name
Customer Number Upload Spreadsheet
Customer Number Upload Spreadsheet (Individuals or Households)
Patent – Power of Attorney or Revocation of Power of Attorney with a New Power of Attorney and Change of Correspondence Address PTO/SB/81 , PTO/AIA/81A, PTO/SB/81A, PTO/AIA/81 Power of Attorney to One or More of The Joint Inventors and Change of Correspondence Address ,   Power of Attorney or Revocation of Power of Attorney with a New Power of Attorney and Change of Correspondence Address ,   Power of Attorney or Revocation of Power of Attorney with a New Power of Attorney and Change of Correspondence Address ,   Patent – Power of Attorney or Revocation of Power of Attorney with a New Power of Attorney and Change of Correspondence Address
Patent – Power of Attorney or Revocation of Power of Attorney with a New Power of Attorney and Change of Correspondence Address (Individuals or Households) PTO/SB/81A, PTO/AIA/81, PTO/SB/81, PTO/AIA/81A Power of Attorney to One or More of The Joint Inventors and Change of Correspondence Address ,   Patent – Power of Attorney or Revocation of Power of Attorney with a New Power of Attorney and Change of Correspondence Address ,   Patent – Power of Attorney or Revocation of Power of Attorney with a New Power of Attorney and Change of Correspondence Address ,   Patent – Power of Attorney or Revocation of Power of Attorney with a New Power of Attorney and Change of Correspondence Address
Petition Under 37 CFR 1.36(a) to Revoke Power of Attorney by Fewer than All the Applicants
Petition to Waive 37 CFR 1.32(b)(4) and Grant Power of Attorney by Fewer than All the Applicants
Power of Attorney or Revocation of Power of Attorney with a New Power of Attorney and Change of Correspondence PTO/AIA/82A/B/C Transmittal for Power of Attorney to One or More Registered Practitioners/Power of Attorney by Applicant
Power of Attorney or Revocation of Power of Attorney with a New Power of Attorney and Change of Correspondence (Individuals or Households) PTO/AIA/82A/B/C Transmittal for Power of Attorney to One or More Registered Practitioners/Power of Attorney by Applicant
Power of Attorney to Prosecute Applications Before the USPTO PTO/SB/80, PTO/AIA/80 Power of Attorney to Prosecute Applications Before the USPTO ,   Power of Attorney to Prosecute Applications Before the USPTO
Power of Attorney to Prosecute Applications Before the USPTO (Individuals or Households) PTO/SB/80, PTO/AIA/80 Power of Attorney to Prosecute Applications Before the USPTO ,   Power of Attorney to Prosecute Applications Before the USPTO
Reexamination – Patent Owner Power of Attorney or Revocation of Power of Attorney with a New Power of Attorney and Change of Correspondence Address PTO/SB/81B, PTO/AIA/81B Reexamination – Patent Owner Power of Attorney or Revocation of Power of Attorney with a New Power of Attorney and Change of Correspondence Address ,   Reexamination – Patent Owner Power of Attorney or Revocation of Power of Attorney with a New Power of Attorney and Change of Correspondence Address
Reexamination – Patent Owner Power of Attorney or Revocation of Power of Attorney with a New Power of Attorney and Change of Correspondence Address (Individuals or Households) PTO/AIA/81B , PTO/SB/81B Reexamination – Patent Owner Power of Attorney or Revocation of Power of Attorney with a New Power of Attorney and Change of Correspondence Address ,   Reexamination – Patent Owner Power of Attorney or Revocation of Power of Attorney with a New Power of Attorney and Change of Correspondence Address
Reexamination – Third Party Requester Power of Attorney or Revocation of Power of Attorney with a New Power of Attorney and Change of Correspondence Address PTO/SB/81C Reexamination – Third Party Requester Power of Attorney or Revocation of Power of Attorney with a New Power of Attorney and Change of Correspondence Address
Reexamination – Third Party Requester Power of Attorney or Revocation of Power of Attorney with a New Power of Attorney and Change of Correspondence Address (Individuals or Households) PTO/SB/81C Reexamination – Third Party Requester Power of Attorney or Revocation of Power of Attorney with a New Power of Attorney and Change of Correspondence Address
Request for Customer Number PTO/SB/125 Request for Customer Number
Request for Customer Number (Individuals or Households) PTO/SB/125 Request for Customer Number
Request for Customer Number Data Change PTO/SB/124 Request for Customer Number Data Change
Request for Customer Number Data Change (Individuals or Households) PTO/SB/124 Request for Customer Number Data Change
Request for Withdrawal as Attorney or Agent and Change of Correspondence Address PTO/SB/83, PTO/AIA/83 Request for Withdrawal as Attorney or Agent and Change of Correspondence Address ,   Request for Withdrawal as Attorney or Agent and Change of Correspondence Address
Request for Withdrawal as Attorney or Agent and Change of Correspondence Address (Individuals or Households) PTO/SB/83, PTO/AIA/83 Request for Withdrawal as Attorney or Agent and Change of Correspondence Address ,   Request for Withdrawal as Attorney or Agent and Change of Correspondence Address
Request to Update a PCT Application with a Customer Number PTO-2248 Request to Update a PCT Application with a Customer Number
Request to Update a PCT Application with a Customer Number (Individuals or Households) PTO-2248 Request to Update a PCT Application with a Customer Number

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 182,085 226,573 0 0 -44,488 0
Annual Time Burden (Hours) 88,922 111,104 0 0 -22,182 0
Annual Cost Burden (Dollars) 24,698 25,855 0 0 -1,157 0
No
No

$1,362,478
No
    Yes
    Yes
No
No
No
No
Parikha Mehta 571 272-3248

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
09/15/2025