Information Collection

User Registration Form

IC 191045 under ICR 201203-1640-002 · OMB 1640-0016.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1640-0016 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form DHS Form 10059 (9/ FRCoP Data Collection Instrument 03/06/2012 User Registration Form	Form and Instruction
DHS Form 10059 (9/ FRCoP Data Collection Instrument 03/06/2012 FRCoP Registration Collection Instrument 03062012.docx communities.firstresponder.gov/web/guest	Form and Instruction

IC Title:

User Registration Form

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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
Form and Instruction	DHS Form 10059 (9/09)			https://communities.firstresponder.gov/web/guest	Yes	Yes	Fillable Printable

Line of Business: Homeland Security

Subfunction: Catastrophic Defense

Privacy Act System of Records

Title: DHS/ALL-002;DHS/ALL-004

FR Citation: 73 FR 71659

Number of Respondents: 2,000

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	2,000	-3,000	5,000
Annual IC Time Burden (Hours)	1,000	-1,500	2,500
Annual IC Cost Burden (Dollars)	50,000	-75,000	125,000

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.

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