Information Collection

Potential Board Member Information

IC 35496 under ICR 201105-3240-003 · OMB 3240-0005.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3240-0005 can be found here:

Documents and Forms

Document Name Document Type
Form SSS Form 404 Potential Board Member Information Form
SSS Form 404 Potential Board Member Information SSS404-U.pdf Form
SSS Form 404 Potential Board Member Information Form SSS404.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Potential Board Member Information	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

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	SSS Form 404	Potential Board Member Information	SSS404-U.pdf		No		Paper Only
Form	SSS Form 404	Potential Board Member Information Form	SSS404.pdf		No		Paper Only

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 900	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	900	900
Annual IC Time Burden (Hours)	225	225
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.