Information Collection

September 11th Victim Compensation Registration Form

IC 199461 under ICR 201109-1123-001 · OMB 1123-0012.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1123-0012 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Screen Shots 09262011.doc	Other-Screen Shots

IC Title:

September 11th Victim Compensation Registration Form

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

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
Other-Screen Shots			Screen Shots 09262011.doc		Yes	Yes	Fillable Fileable

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 70,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 75 %

table that charts list of burden
	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	70,000	70,000
Annual IC Time Burden (Hours)	23,100	23,100
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.