Information Collection

State, Local or Tribal Government

IC 187613 under ICR 200812-1090-001 · OMB 1090-0009.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1090-0009 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
State, Local or Tribal Government	Form
Donor Certification Form DOI Donor Certification Form FINAL 4.17.09.doc www.doi.gov/pmb	Form

IC Title:

State, Local or Tribal Government

Agency IC Tracking Number:

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	None	Donor Certification Form	DOI Donor Certification Form FINAL 4.17.09.doc	http://www.doi.gov/pmb	Yes	Yes	Fillable Fileable

Line of Business: General Government

Subfunction: Central Property Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 16

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	16	16
Annual IC Time Burden (Hours)	5	5
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.