View Information Collection Request (ICR) Package

View ICR - Agency Submission

Comment Period Closed - Comments are accepted for the first 30 days of OIRA's review. See FAQ page for more information.

OMB Control No: 1140-0094	ICR Reference No: 202510-1140-005
Status: Received in OIRA	Previous ICR Reference No: 202207-1140-003
Agency/Subagency: DOJ/ATF	Agency Tracking No:
Title: Certification of Qualifying State Relief from Disabilities Program (ATF Form 3210.12)
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular	Date Submitted to OIRA: 11/30/2025

	Requested	Previously Approved
Expiration Date	36 Months From Approved	01/31/2026
Responses	10	50
Time Burden (Hours)	3	13
Cost Burden (Dollars)	0	29

Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination. No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination. No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

Agency Contact: Jennifer Scott 202 302-0578