Information Collection

Affidavit Declaring Domestic Partner Relationship

IC 208315 under ICR 201004-0420-001 · OMB 0420-0554.

Documents and Forms

Document Name Document Type
Form PC-2109 Affidavit Declaring Domestic Partner Relationship Form and Instruction
PC-2109 Affidavit Declaring Domestic Partner Relationship Affidavit Declaring Domestic Partner Relationship (12-2013).pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Affidavit Declaring Domestic Partner Relationship	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	PC-2109	Affidavit Declaring Domestic Partner Relationship	Affidavit Declaring Domestic Partner Relationship (12-2013).pdf		Yes	Yes	Fillable Fileable

Line of Business: International Affairs and Commerce

Subfunction: International Development and Humanitarian Aid

Privacy Act System of Records
Title: PC17 (Volunteer Records)	FR Citation: 70 FR 1

Number of Respondents: 325	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 99 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	325	325
Annual IC Time Burden (Hours)	11	11
Annual IC Cost Burden (Dollars)	0	0

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.