Information Collection

Application Survey

IC 204865 under ICR 201211-3170-005 · OMB 3170-0030.

Documents and Forms

Document Name Document Type
Form 3170-XXXX Application Survey Form and Instruction
Script for Introducing the Research Study FINAL.pdf Instruction
3170-XXXX Consent for Participation in Research Consent for Participation in Research FINAL.pdf Form and Instruction
3170-XXXX Application Survey & Script Application Survey & Script FINAL.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Application Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	3170-XXXX	Application Survey & Script	Application Survey & Script FINAL.pdf	Yes	No	Fillable Printable
Instruction			Script for Introducing the Research Study FINAL.pdf	Yes	No	Printable Only
Form and Instruction	3170-XXXX	Consent for Participation in Research	Consent for Participation in Research FINAL.pdf	Yes	No	Fillable Printable

Line of Business: Economic Development

Subfunction: Financial Sector Oversight

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,000	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	1,000	1,000
Annual IC Time Burden (Hours)	167	167
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.