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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Identity Theft Questionnaire	Agency IC Tracking Number:

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
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 %

	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

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.