OMB control number
Certification of Qualifying State Relief from Disabilities Program (ATF Form 3210.12)
OMB 1140-0094 · DOJ/ATF.
OMB 1140-0094
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.
The latest form for Certification of Qualifying State Relief from Disabilities Program (ATF Form 3210.12) expires 2029-05-31 and can be found here.
Latest Forms, Documents, and Supporting Material
Document Name |
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Form and Instruction |
Form and Instruction |
Supplementary Document |
Supplementary Document |
Supporting Statement A |
Supplementary Document |
Form 3210.12 Certification of Qualifying State Relief from Disabilities Program
1140-0094 supporting statement part A 2025.w mon.docx
Certification of Qualifying State Relief From Disabilities Program All Historical Document Collections
| Extension without change of a currently approved collection | 2025-11-30 | ||
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Approved without change |
Extension without change of a currently approved collection | 2022-08-05 | |
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Approved without change |
Extension without change of a currently approved collection | 2019-05-31 | |
|
Approved without change |
Revision of a currently approved collection | 2016-03-29 | |
|
Approved without change |
Revision of a currently approved collection | 2013-01-30 | |
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Approved without change |
Extension without change of a currently approved collection | 2009-11-24 | |
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Approved without change |
New collection (Request for a new OMB Control Number) | 2009-04-23 |