Information Collection

Notice for Certificate of Data Destruction

IC 183230 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⚠️ Notice: This information collection may be referencing outdated material.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 10042 (12/07) Notice for Certificate of Data Destruction	Form and Instruction
10042 (12/07) Notice for Certificate of Data Destruction 10042_PREDICT_Data Destruction_v2.0.docx	Form and Instruction

IC Title:

Notice for Certificate of Data Destruction

Agency IC Tracking Number:

10042

Is this a Common Form? No

IC Status: Modified

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	10042 (12/07)	Notice for Certificate of Data Destruction	10042_PREDICT_Data Destruction_v2.0.docx		Yes	No	Fillable Printable

Line of Business: Homeland Security

Subfunction: Key Asset and Critical Infrastructure Protection

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 15

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
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	15	5	10
Annual IC Time Burden (Hours)	4	1	3
Annual IC Cost Burden (Dollars)	0	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.