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[{"$nulls":8},"ATTACHMENT III"]
[{"$nulls":6},"Survey Form sent to State Reporting Agencies"]
["Survey for 2010 Firearm Inquiry Statistics (FIST) Program",{"$nulls":12},"OMB No. XXXX-XXXX:  Approval expires XX/XX/XXXX"]
["State Agency Name:",{"$nulls":12},"Agency Number:"]
[]
[null,"APPLICATIONS",null,null,"REASONS FOR REJECTION",{"$nulls":9},"  APPEALS/ARRESTS**"]
["Month","RCVD","REJ","REJ RATE","FEL","FUG","JUV","DOM VIOL","CRT ORD","ILLGL ALIEN","MNTL HLTH","DRUG ADD","STATE LAW","OTHER*","ARRESTS","APPEALS","APPEALS REVRSD","RECONSD RCVD†","RECONSD REVRSD"]
["Jan"]
["Feb"]
["Mar"]
["April"]
["May"]
["June"]
["July"]
["Aug"]
["Sep"]
["Oct"]
["Nov"]
["Dec"]
["TOTAL"]
["          *Other includes dishonorable discharge, renunciation of U.S. citizenship, and unspecified reasons.  "]
["        **Arrest and appeal counts can be sent later, if more time is needed to collect data."]
["        † A reconsideration occurs when the denied person objects to the original decision and asks your agency to reconsider the denial.               "]
[]
["Directions: If monthly totals are not available, please fill in the cumulative totals for at least the first two columns. In the event data are reported on the"]
["spreadsheet, please review the accuracy of the information and make updates directly to the form as needed. In order for us to complete our analyses of"]
["the 2010 data, we would greatly appreciate if you would return the completed spreadsheet and your signed review by <date>. The materials can be returned"]
["via fax, mail, or email (information below)."]
["Thank you for your time and effort. Please do not hesitate to contact us at 1-800-XXX-XXXX or XXX@XXX.com with any questions regarding this survey."]
[]
["Completed by: ",{"$nulls":13},"MAIL: ","FIST"]
["Telephone:",{"$nulls":14},"<Data collection agent>"]
["Fax:",{"$nulls":14},"<Address>"]
["Email:",{"$nulls":14},"<City, State, Zip Code>"]

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