Information Collection

Supplement Experience Statement

IC 176599 under ICR 197906-3206-007 · OMB 3206-0038.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3206-0038 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type

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IC Title:

SUPPLEMENT EXPERIENCE STATEMENT

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Migrated

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CSC 1170				No	No

Line of Business:

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 987,832

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	987,832	13,333	974,499
Annual IC Time Burden (Hours)	578,869	27,106	551,763
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded

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