Information Collection

Exit Form

IC 185981 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 10054 (5/ Exit Form	Form and Instruction
DHs Form 10054 (5/ Exit Form Exit Form.pdf surveys.jsc.eku.edu/mrIWeb/mrIWeb.dll?I.Project=NOEAEXITFORM	Form and Instruction

IC Title:

Exit Form

Agency IC Tracking Number:

DHS Form 10054 (5/08)

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 10054 (5/08)	Exit Form	Exit Form.pdf	http://surveys.jsc.eku.edu/mrIWeb/mrIWeb.dll?I.Project=NOEAEXITFORM	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	100	100
Annual IC Time Burden (Hours)	20	20
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.