Information Collection

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

IC 144126 under ICR 198207-2502-002 · OMB 2502-0222.

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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:

table that charts list of 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: 300

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	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	500	67	58	375
Annual IC Time Burden (Hours)	750	-400	-350	1,500
Annual IC Cost Burden (Dollars)	0	0	0	0

Documents for IC

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Title	Document	Date Uploaded

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