Applicant's Certification that it Does not Support Terrorist Organizations or Individuals

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0412-0565 can be found here:

Documents and Forms

Document Name Document Type
OMB - Supporting Statement - Certification - 0412-0565 - 2010.doc Other-Certification

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Applicant's Certification that it Does not Support Terrorist Organizations or Individuals	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 22 CFR 226

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Certification			OMB - Supporting Statement - Certification - 0412-0565 - 2010.doc		Yes	Yes	Fillable Printable

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,000	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Previously Approved
Annual Number of Responses for this IC	4,000	4,000
Annual IC Time Burden (Hours)	1,500	1,500
Annual IC Cost Burden (Dollars)	93,000	93,000

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.