Information Collection

CIS OMBudsman Case Problem Submission Form

IC 44790 under ICR 200608-1615-001 · OMB 1615-0103.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form DHS-7001 CIS Ombudsman Case Problem Submission Form	Form and Instruction
DHS-7001 CIS Ombudsman Case Problem Submission Worksheet DHS-7001 8-31-06.pdf	Form and Instruction

IC Title:

CIS Ombudsman Case Problem Submission Form

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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
Form and Instruction	DHS-7001	CIS Ombudsman Case Problem Submission Worksheet	DHS-7001 8-31-06.pdf		Yes	No	Fillable Printable

Line of Business:

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,600

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
Annual Number of Responses for this IC	2,600	2,600
Annual IC Time Burden (Hours)	2,600	2,600
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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