Information Collection

International Terrorism Victim Expense Reimbursement Program

IC 192597 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⚠️ Notice: This information collection may be referencing outdated material.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
International Terrorism Victim Expense Reimbursement Program	Form
Application Instructions.rtf	Instruction
Application Supplemental.rtf	Other-application supplemental
International Terrorism Victim Expense Reimbursement Pro Application.rtf	Form

IC Title:

International Terrorism Victim Expense Reimbursement Program

Agency IC Tracking Number:

OVC

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	Available Electronically?	Electronic Capability
Form	None	International Terrorism Victim Expense Reimbursement Program	Application.rtf	No	Printable Only
Instruction			Application Instructions.rtf	No	Printable Only
Other-application supplemental			Application Supplemental.rtf	No	Printable Only

Line of Business: International Affairs and Commerce

Subfunction: International Development and Humanitarian Aid

Privacy Act System of Records

Title:

FR Citation:

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
	Approved	Program Change Due to Agency Discretion
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.