Information Collection

Structured Assessment Case Free Form Query

IC 185980 under ICR 200807-1640-001 · OMB 1640-0014.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form DHS Form 10053 (5/ Structured Assessment Case Free Form Query	Form and Instruction
DHS Form 10053 (5/ Structured Assessment Case: Free Form Query Structured Assessment Case Free Form Query.pdf surveys.jsc.eku.edu/mrIWeb/mrIWeb.dll?I.Project=NOEAFREEFORMQUER	Form and Instruction

IC Title:

Agency IC Tracking Number:

DHS Form 10053 (05/08)

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 10053 (5/08)	Structured Assessment Case: Free Form Query	Structured Assessment Case Free Form Query.pdf	http://surveys.jsc.eku.edu/mrIWeb/mrIWeb.dll?I.Project=NOEAFREEFORMQUER	Yes	Yes	Fillable Fileable Signable

Line of Business: Homeland Security

Subfunction: Key Asset and Critical Infrastructure Protection

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 100

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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	200	200
Annual IC Time Burden (Hours)	100	100
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.