Information Collection

Web Intake Form

IC 198053 under ICR 201107-1505-005 · OMB 1505-0236.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
6.9.11 Complaint intake screenshot 1.png	Other-Screen Shot
6.9.11 Complaint intake screenshot 1.1.png	Other-Screen Shot
6.9.11 Complaint intake screenshot 2.png	Other-Screen Shot
6.9.11 Complaint intake screenshot 3.png	Other-Screen Shot
6.9.11 Complaint intake screenshot 3.1.png	Other-Screen Shot

IC Title:

Web Intake Form

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	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Screen Shot	6.9.11 Complaint intake screenshot 1.png	Yes	Yes	Fillable Fileable
Other-Screen Shot	6.9.11 Complaint intake screenshot 1.1.png	Yes	Yes	Fillable Fileable
Other-Screen Shot	6.9.11 Complaint intake screenshot 2.png	Yes	Yes	Fillable Fileable
Other-Screen Shot	6.9.11 Complaint intake screenshot 3.png	Yes	Yes	Fillable Fileable
Other-Screen Shot	6.9.11 Complaint intake screenshot 3.1.png	Yes	Yes	Fillable Fileable

Line of Business: Economic Development

Subfunction: Industry Sector Income Stabilization

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 56,250

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 60 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	56,250	56,250
Annual IC Time Burden (Hours)	6,563	6,563
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.