Information Collection

Affidavit Declaring Domestic Partner Relationship

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

Documents and Forms

Documents and forms in this information collection
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

IC Title:

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:

table that charts list of 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 %

table that charts list of burden
	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

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.