Information Collection

1) Statement Of Facts 2) Supplement To Statement Of Facts

IC 144125 under ICR 198202-2502-001 · OMB 2502-0222.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2502-0222 can be found here:

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Information Collection (IC) Details

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IC Title:	1) STATEMENT OF FACTS 2) SUPPLEMENT TO STATEMENT OF FACTS	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

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

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 250	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	375	375
Annual IC Time Burden (Hours)	1,500	1,500
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.