Information Collection

Humanitarian Program Application

IC 197192 under ICR 201207-0651-005 · OMB 0651-0066.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0651-0066 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Humanitarian research form.doc Humanitarian Research Form	IC Document
Humanitarian use form.doc Humanitarian Use Form	IC Document
Patents for humanity Contact Information.v2.doc Contact Info Form	IC Document

IC Title:

Humanitarian Program Application

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 37 CFR 1.102

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

Line of Business: Economic Development

Subfunction: Intellectual Property Protection

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,000

Number of Respondents for Small Entity: 330

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	1,000	1,000
Annual IC Time Burden (Hours)	4,000	4,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Humanitarian Research Form	Humanitarian research form.doc	07/12/2012
Humanitarian Use Form	Humanitarian use form.doc	07/12/2012
Contact Info Form	Patents for humanity Contact Information.v2.doc	07/12/2012

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