Historical Records Services Request

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1615-0096 can be found here:

Documents and Forms

Document Name Document Type
Form G-1041A Historical Records Services Request Form
G-1041instr.pdf Instruction
G-1041Ainstr.pdf Instruction
G-1041 Historical Records Services Request G-1041 Form.pdf Form
G-1041A Geneology Records Request G-1041A Form.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Historical Records Services Request	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 8 CFR 103

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	G-1041A	Geneology Records Request	G-1041A Form.pdf	Yes	Yes	Fillable Fileable
Instruction			G-1041Ainstr.pdf	Yes	No	Printable Only
Form	G-1041	Historical Records Services Request	G-1041 Form.pdf	Yes	Yes	Fillable Fileable
Instruction			G-1041instr.pdf	Yes	No	Printable Only

Line of Business: Homeland Security

Subfunction: Border and Transportation Security

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 26,597	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 30 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	26,597	10,597	16,000
Annual IC Time Burden (Hours)	13,299	5,299	8,000
Annual IC Cost Burden (Dollars)	602,860	88,860	514,000

Documents for IC

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.