Information Collection

Information Request

IC 181788 under ICR 201007-1640-001 · OMB 1640-0011.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form DHS Form 10012 (04 Information Request	Form and Instruction
DHS Form 10012 (04 Information Request DHS Form 10012 - Information Request.pdf www.techsolutions.dhs.gov	Form and Instruction

IC Title:

Information Request

Agency IC Tracking Number:

10012

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 Form 10012 (04/07)	Information Request	DHS Form 10012 - Information Request.pdf	https://www.techsolutions.dhs.gov	Yes	Yes	Fillable Fileable

Line of Business: Homeland Security

Subfunction: Catastrophic Defense

Privacy Act System of Records

Title: DHS/ALL-004

FR Citation: 74 FR 49882

Number of Respondents: 22

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	22	-228	250
Annual IC Time Burden (Hours)	2	-19	21
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.