OMB Control #3265-0004
Form EAC 003C
This form provides for the reporting of voting system anomalies by
election officials. This form is part of the EAC Quality Monitoring Program.
The use of this form is voluntary. Information regarding its use can be found
in Section 8.7 of the Manual.
This form is self-explanatory.
Anomaly Reporting Form
This information is required for the EAC to provide for the certification of voting
systems as required by 42 U.S.C. Section 15371. This information will be used solely to
administer the EAC Testing and Certification Program. This program is voluntary, however,
individuals who wish to participate must meet the requirements of the Program. This
information will be made public consistent with the requirements of the Freedom of
Information Act, the Trade Secrets Act, and any other applicable Federal law or
regulation. Public reporting burden for this collection of information is estimated to
average about 82 hours for completion of this form. This estimate includes the time for
reviewing the instructions, gathering information and completing the form. Send comments
regarding this burden estimate to the Testing and Certification Program Director,
Election Assistance Commission, 1201 New York Avenue, NW, Suite 300, Washington, DC
20005. Not withstanding any other provision of law, no person is required to respond to,
nor shall any person be subject to apenalty for failure to respond to, or comply with,
a collection of information subject to the requirements of the Paperwork Reduction Act,
unless that collection of information displays a currently valid OMB Control Number.