Information Collection

Police Record Check

IC 5241 under ICR 199708-0704-003 · OMB 0704-0007.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0704-0007 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	Police Record Check	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	369				Yes	Yes

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 125,000	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 10 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	125,000	125,000
Annual IC Time Burden (Hours)	56,250	56,250
Annual IC Cost Burden (Dollars)	5,000	5,000

Documents for IC

Title	Document	Date Uploaded

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