Information Collection

Freedom of Information/Privcy Act Request

IC 21021 under ICR 200907-1615-001 · OMB 1615-0102.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1615-0102 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form G-639 Freedom of Information/Privcy Act Request	Form
G-639 Instructions 2-04-09 Rev.pdf	Instruction
G-639 Freedom of Information/Privcy Act Request G-639 Form 2-04-09 Rev.pdf	Form

IC Title:

Freedom of Information/Privcy Act Request

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 8 CFR 103

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	G-639	Freedom of Information/Privcy Act Request	G-639 Form 2-04-09 Rev.pdf		Yes	No	Fillable Printable
Instruction			G-639 Instructions 2-04-09 Rev.pdf		Yes	No	Paper Only

Line of Business: Homeland Security

Subfunction: Border and Transportation Security

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 100,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	100,000	100,000
Annual IC Time Burden (Hours)	25,000	25,000
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.