Information Collection

Statement Of Annual Estimated Personal & Family Expenses

IC 130039 under ICR 198109-1545-100 · OMB 1545-0514.

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Information Collection (IC) Details

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IC Title:	STATEMENT OF ANNUAL ESTIMATED PERSONAL & FAMILY EXPENSES	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	4822				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 107,275	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	107,275	107,275
Annual IC Time Burden (Hours)	53,637	53,637
Annual IC Cost Burden (Dollars)	0	0

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