Information Collection Request

Application for Domestic Indemnification

ICR 201103-3135-005 · OMB 3135-0123 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 3135-0123 Application for Indemnity Form and Instruction New Available
DomesticG'lines July 2011 deadline.pdf Supplementary Document Uploaded 2011-06-27 Available
Supporting Statement 2007.doc Supporting Statement A Uploaded 2011-05-05 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
198284 Application for Indemnity Form and Instruction New

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
07/31/2014 36 Months From Approved 08/31/2011
50 0 100
2,000 0 4,500
90,000 0 180,000





Reginfo record details
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table that charts list of burden
IC Title Form No. Form Name
Application for Indemnity 3135-0123 Application for Indemnity

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 50 100 0 0 -50 0
Annual Time Burden (Hours) 2,000 4,500 0 0 -2,500 0
Annual Cost Burden (Dollars) 90,000 180,000 0 0 -90,000 0


Reginfo record details
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