Information Collection

Identity Theft Questionnaire

IC 205194 under ICR 201112-1505-003 · OMB 1505-0217.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1505-0217 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Identity Theft Questionnaire (2012-2013).docx	Other-Questionnaire
Identity Theft Questionnaire_Cover Letter (Draft).doc	Other-Cover Letter
Justification GEN IC Identity Theft Victim Assistance 12142012.doc Supporting Statement Identity Theft	IC Document

IC Title:

Identity Theft Questionnaire

Agency IC Tracking Number:

IC Status: New

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
Other-Questionnaire			Identity Theft Questionnaire (2012-2013).docx		Yes	No	Paper Only
Other-Cover Letter			Identity Theft Questionnaire_Cover Letter (Draft).doc		Yes	No	Paper Only

Line of Business: General Government

Subfunction: Taxation Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 300

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	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	300	300
Annual IC Time Burden (Hours)	75	75
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement Identity Theft	Justification GEN IC Identity Theft Victim Assistance 12142012.doc	01/02/2013

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.