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Statement of Personal History
Statement of Personal History
OMB: 3245-0178
IC ID: 35707
OMB.report
SBA
OMB 3245-0178
ICR 200609-3245-008
IC 35707
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3245-0178 can be found here:
2022-10-25 - Extension without change of a currently approved collection
2019-05-29 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
Form 912
Statement of Personal History
Form
912 Statement of Personal History
Pages from sba912current-2.pdf
www.sba.gov/sbaforms/sba912.pdf
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Statement of Personal History
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
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
912
Statement of Personal History
Pages from sba912current-2.pdf
www.sba.gov/sbaforms/sba912.pdf
No
Printable Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Workforce Management
Subfunction:
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
142,000
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
142,000
0
0
87,000
0
55,000
Annual IC Time Burden (Hours)
35,500
0
0
21,750
0
13,750
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
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.