Information Collection

Applicant's Voluntary Self-Identification Form

IC 182371 under ICR 200801-7100-005 · OMB 7100-0181.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 7100-0181 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form FR 28s Applicant's Voluntary Self-Identification Form	Form
FR 28s Applicant's Voluntary Self-Indentification Form FR28s.200412.Self.ID_f.pdf	Form

IC Title:

Applicant's Voluntary Self-Identification Form

Agency IC Tracking Number:

FR 28s

Is this a Common Form? No

IC Status: Unchanged

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	FR 28s	Applicant's Voluntary Self-Indentification Form	FR28s.200412.Self.ID_f.pdf		Yes	Yes	Printable Only

Line of Business: Economic Development

Subfunction: Financial Sector Oversight

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 75 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	2,000	2,000
Annual IC Time Burden (Hours)	33	33
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.