Information Collection

Account Request Form

IC 183216 under ICR 200801-1640-001 · OMB 1640-0012.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1640-0012 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 10029 (12/07) Account Request Form	Form and Instruction
10029 (12/07) PREDIC T Account Request Form PREDICT_Account_Request.pdf	Form and Instruction
PREDICT_Account_Request.pdf Account Request Screen Shot	IC Document

IC Title:

Account Request Form

Agency IC Tracking Number:

10029

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 and Instruction	10029 (12/07)	PREDIC T Account Request Form	PREDICT_Account_Request.pdf		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: 37

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions, 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	37	37
Annual IC Time Burden (Hours)	9	9
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Account Request Screen Shot	PREDICT_Account_Request.pdf	04/15/2008

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