CIS OMBudsman Case Problem Submission Form

CIS Ombudsman Case Problem Submission Worksheet

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1601-0004 can be found here:

Documents and Forms

Document Name Document Type
Form DHS-7001 CIS Ombudsman Case Problem Submission Form Form and Instruction
Screenshots_09142010[1].pdf Other-Screenshots
DHS-7001 CIS Ombudsman Case Problem Submission Worksheet DHS_Form7001_7_9_10.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	CIS Ombudsman Case Problem Submission Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

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	DHS-7001	CIS Ombudsman Case Problem Submission Worksheet	DHS_Form7001_7_9_10.pdf		Yes	No	Fillable Printable
Other-Screenshots			Screenshots_09142010[1].pdf		Yes	Yes	Fillable Fileable Signable

Line of Business: Homeland Security

Subfunction: Border and Transportation Security

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,600	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	2,600	2,600
Annual IC Time Burden (Hours)	2,600	2,600
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.