Information Collection

Amendment to Research/User Agreement

IC 194246 under ICR 201203-1640-003 · OMB 1640-0012.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 10060 (04/10) Amendment to Research/User Agreement	Form and Instruction
10060 (04/10) Amendment to Research/User Agreement 10060_PREDICT_MOA_Amendment_PrincipalResearcher_Final_10-7-11.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

10060

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	10060 (04/10)	Amendment to Research/User Agreement	10060_PREDICT_MOA_Amendment_PrincipalResearcher_Final_10-7-11.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	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	15	10	5
Annual IC Time Burden (Hours)	4	3	1
Annual IC Cost Burden (Dollars)	0	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.