CIS OMBudsman Case Problem Submission Form

CIS Ombudsman Case Problem Submission Worksheet

Documents and Forms

Document Name Document Type
Form DHS-7001 CIS Ombudsman Case Problem Submission Form Form and Instruction
DHS-7001 CIS Ombudsman Case Problem Submission Worksheet DHS-7001 8-31-06.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	CIS Ombudsman Case Problem Submission Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	DHS-7001	CIS Ombudsman Case Problem Submission Worksheet	DHS-7001 8-31-06.pdf		Yes	No	Fillable Printable

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,600	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,600	2,600
Annual IC Time Burden (Hours)	2,600	2,600
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.