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Federal forms, ICRs, and supporting documents

Information Collection Request

Certification of Qualifying State Relief from Disabilities Program (ATF Form 3210.12)

ICR 202510-1140-005 · OMB 1140-0094 · Active

Forms and Documents
DocumentTypeStatusAvailability
Form 3210.12 Certification of Qualifying State Relief from Disabilities Program Form and Instruction Modified Available
Form 3210.12 Certification of Qualifying State Relief From Disabilities Program Form and Instruction Modified Available
PL 110-180 (NIAA).pdf Supplementary Document Uploaded 2022-08-05 Repair queued
PL 110-180 (NIAA).pdf Supplementary Document Uploaded 2022-08-05 Available
27 CFR 478.11 Meaning of Terms 4.1.2021.pdf Supplementary Document Uploaded 2022-08-05 Repair queued
27 CFR 478.11 Meaning of Terms 4.1.2021.pdf Supplementary Document Uploaded 2022-08-05 Available
1140-0094 supporting statement part A 2025.w mon.docx Supporting Statement A Uploaded 2025-11-03 Repair queued
1140-0094 supporting statement part A 2025.w mon.docx Supporting Statement A Uploaded 2025-11-03 Available
18 USC 922 Unlawful Acts 12.31.2020.pdf Supplementary Document Uploaded 2022-08-05 Repair queued
18 USC 922 Unlawful Acts 12.31.2020.pdf Supplementary Document Uploaded 2022-08-05 Available
IC Document Collections
IC IDCollectionTypeStatusForm
188936 Certification of Qualifying State Relief From Disabilities Program Form and Instruction ModifiedCertification of Qualifying State Relief from Disabilities Program
188936 Certification of Qualifying State Relief From Disabilities Program Form and Instruction Modified
ICR Details
1140-0094 202510-1140-005
Active 202207-1140-003
DOJ/ATF
Certification of Qualifying State Relief from Disabilities Program (ATF Form 3210.12)
Extension without change of a currently approved collection   No
Regular
Approved without change 05/11/2026
Retrieve Notice of Action (NOA) 11/30/2025
In accordance with 5 CFR 1320, this information collection is approved
  Inventory as of this Action Requested Previously Approved
05/31/2029 36 Months From Approved 05/31/2026
10 0 50
3 0 13
0 0 29
NICS Improvement Act sought to address gap in information from states about mental health adjudications/commitments prohibiting purchase of firearms. It authorizes grants for states to improve quality and completeness of records available to NICS, but to qualify for a grant, a state official must certify to ATF that the state has implemented a qualifying program permitting persons adjudicated as a mental defective, or committed to an institution to apply for relief from that firearms disability.
US Code: 18 USC 922 Name of Law: Unlawful Acts
  
None
Not associated with rulemaking
  90 FR 37567 08/05/2025
90 FR 51410 11/17/2025
No
  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 10 50 0 0 -40 0
Annual Time Burden (Hours) 3 13 0 0 -10 0
Annual Cost Burden (Dollars) 0 29 0 -6 -23 0
No
No
$0
No
    No
    No
No
No
No
No
Jennifer Scott 202 302-0578
  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.
11/30/2025