Information Collection

Consumer Response Intake Form (Paper/Telephone)

IC 198358 under ICR 201111-3170-004 · OMB 3170-0011.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3170-0011 can be found here:

Documents and Forms

Document Name Document Type
Form TD F 104.3 Consumer Response Intake Form (Paper/Telephone) Form
TD F 104.3 Consumer Response Intake Form Paper Intake Form Mock Up 10 7 11 821a.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Consumer Response Intake Form (Paper/Telephone)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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	TD F 104.3	Consumer Response Intake Form	Paper Intake Form Mock Up 10 7 11 821a.pdf		Yes	No	Printable Only

Line of Business: Economic Development

Subfunction: Industry Sector Income Stabilization

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 750,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	750,000	750,000
Annual IC Time Burden (Hours)	125,000	125,000
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.