Information Collection

Statement and Acknowledgment (SF 1413); FAR sections affected; 22.406-5, 22.407(a), 52.222-11(b), 53.222(e), 53.301-SF 1413

IC 36405 under ICR 200103-9000-004 · OMB 9000-0014.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 9000-0014 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type

No indexed documents/forms are available for this IC yet. A refresh has been queued.

IC Title:

Statement and Acknowledgment (SF 1413); FAR sections affected; 22.406-5, 22.407(a), 52.222-11(b), 53.222(e), 53.301-SF 1413

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:

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: 31,500

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	63,000	42,000	21,000
Annual IC Time Burden (Hours)	3,150	0	3,150
Annual IC Cost Burden (Dollars)	0	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.