Information Collection

Identity Theft Questionnaire

IC 205194 under ICR 201301-1505-002 · OMB 1505-0217.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1505-0217 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Identity Theft Questionnaire_Cover Letter (Draft).doc	Other-Cover Letter
Identity Theft Questionnaire (2012-2013) 1_17.docx	Other-Questionnaire-REV
Justification GEN IC Identity Theft Victim Assistance 12142012.doc Supporting Statement Identity Theft	IC Document
Justification for Change.docx Justification for Change	IC Document

IC Title:

Identity Theft Questionnaire

Agency IC Tracking Number:

IC Status: Modified

Obligation to Respond: Voluntary

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
Other-Cover Letter			Identity Theft Questionnaire_Cover Letter (Draft).doc		Yes	No	Paper Only
Other-Questionnaire-REV			Identity Theft Questionnaire (2012-2013) 1_17.docx		Yes	No	Printable Only

Line of Business: General Government

Subfunction: Taxation Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 300

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	300	300
Annual IC Time Burden (Hours)	75	75
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement Identity Theft	Justification GEN IC Identity Theft Victim Assistance 12142012.doc	01/02/2013
Justification for Change	Justification for Change.docx	01/30/2013

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