Information Collection

Email Mailing List Signup

IC 182282 under ICR 200710-1640-001 · OMB 1640-0009.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form DHS Form 10016 Email Mailing List Signup	Form
DHS Form 10016 E-mail List sign-up DHS Form 1640-10016- Screen Shot.pdf demo.sainc.com/hsarpasbir/mailinglist/newmailinguser.asp	Form

IC Title:

Agency IC Tracking Number:

DHS Form 10016

Is this a Common Form? No

IC Status: New

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
Form	DHS Form 10016	E-mail List sign-up	DHS Form 1640-10016- Screen Shot.pdf	http://demo.sainc.com/hsarpasbir/mailinglist/newmailinguser.asp	Yes	Yes	Fillable Fileable

Line of Business: Homeland Security

Subfunction: Key Asset and Critical Infrastructure Protection

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 300

Number of Respondents for Small Entity: 300

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

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	300	300
Annual IC Time Burden (Hours)	50	50
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.