Information Collection

Notice for Certificate of Data Disposal

IC 183230 under ICR 201203-1640-003 · OMB 1640-0012.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 10042 (12/07) Notice for Certificate of Data Disposal	Form and Instruction
10042 (12/07) PREDICT Notice for Certificate of Data Disposal 10042_PREDICT_Data-Disposal_v2.0.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

10042

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	10042 (12/07)	PREDICT Notice for Certificate of Data Disposal	10042_PREDICT_Data-Disposal_v2.0.pdf		Yes	No	Fillable Printable

Line of Business: Homeland Security

Subfunction: Key Asset and Critical Infrastructure Protection

Privacy Act System of Records

Title: SORN DHS/ALL-002

FR Citation: 73 FR 71659

Number of Respondents: 15

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	15	15
Annual IC Time Burden (Hours)	4	4
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.