Information Collection

843 Claim, Information Requested

IC 129644 under ICR 198108-1545-058 · OMB 1545-0288.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type

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IC Title:

843 CLAIM, INFORMATION REQUESTED

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Migrated

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?
Form	178C	No	No
Form	178SC	No	No
Form	178SP	No	No

Line of Business:

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,016

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
Annual Number of Responses for this IC	1,016	1,016
Annual IC Time Burden (Hours)	339	339
Annual IC Cost Burden (Dollars)	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.