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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

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.