Information Collection

International Terrorism Victim Expense Reimbursement Program Application

IC 12629 under ICR 201003-1121-002 · OMB 1121-0309.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1121-0309 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
(D-1) Application Instructions-Final rev 82406.baw.rtf DRW1.rtf	Instruction
(D-1) Application Supplemental-Current rev baw.rtf	Other-Supplement to Application
International Terrorism Victim Expense Reimbursement Pro REVISED ITVERP Application w Waiver082406.baw.rtf	Form

IC Title:

International Terrorism Victim Expense Reimbursement Program Application

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 28 CFR 94

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Electronic Capability
Instruction			(D-1) Application Instructions-Final rev 82406.baw.rtf DRW1.rtf	No	Paper Only
Other-Supplement to Application			(D-1) Application Supplemental-Current rev baw.rtf	No	Paper Only
Form	None	International Terrorism Victim Expense Reimbursement Program Application	REVISED ITVERP Application w Waiver082406.baw.rtf	No	Paper Only

Line of Business: Litigation and Judicial Activities

Subfunction: Resolution Facilitation

Privacy Act System of Records

Title: Victims of International Terrorism Expense Reimbursement Program

FR Citation: 71 FR 44709

Number of Respondents: 2,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-2,000	2,000
Annual IC Time Burden (Hours)	-1,500	1,500
Annual IC Cost Burden (Dollars)	-6,000	6,000

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.