Information Collection

Information Request Form

IC 181788 under ICR 200708-1640-001 · OMB 1640-0011.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1640-0011 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form DHS Form Information Request Form	Form and Instruction
DHS Form Information Request Form DHS Form - Information Request Form.pdf	Form and Instruction

IC Title:

Information Request 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 Form	Information Request Form	DHS Form - Information Request Form.pdf		Yes	Yes	Fillable Fileable

Line of Business: Homeland Security

Subfunction: Catastrophic Defense

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 250

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	250	250
Annual IC Time Burden (Hours)	21	21
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.