Information Collection

Update Provider Data Form

IC 183221 under ICR 201006-1640-002 · OMB 1640-0012.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1640-0012 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 10034 (12/07) Update Provider Data Form	Form and Instruction
10034 (12/07) Update Provider Data PREDICT_UpdateProvider.pdf	Form and Instruction

IC Title:

Update Provider Data Form

Agency IC Tracking Number:

10034

Is this a Common Form? No

IC Status: Removed

Obligation to Respond: Voluntary

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	10034 (12/07)	Update Provider Data	PREDICT_UpdateProvider.pdf		Yes	Yes	Fillable Fileable

Line of Business: Homeland Security

Subfunction: Key Asset and Critical Infrastructure Protection

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 10

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-10	10
Annual IC Time Burden (Hours)	-3	3
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.