Information Collection

CIS OMBudsman Case Problem Submission Form

IC 44790 under ICR 201007-1601-001 · OMB 1601-0004.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

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:

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	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 %

table that charts list of burden
	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

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.