Information Collection

Application for Data License

IC 206961 under ICR 201312-2528-002 · OMB 2528-0297.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2528-0297 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Application for Data License	Form
License for the Use of Personally Identifiable Information License Affidavit (2).docx	Other-Affidavit of Nondisclosure
PDR License Agreement 9-23-2013.docx	Other-PDR License Aggreement
Application for Data License License for the Use of Personally Identifiable Information Application for Data License.docx	Form

IC Title:

Application for Data License

Agency IC Tracking Number:

Is this a Common Form? No

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	N/A	Application for Data License	License for the Use of Personally Identifiable Information Application for Data License.docx	Yes	Yes	Fillable Fileable
Other-Affidavit of Nondisclosure			License for the Use of Personally Identifiable Information License Affidavit (2).docx	Yes	Yes	Fillable Fileable
Other-PDR License Aggreement			PDR License Agreement 9-23-2013.docx	Yes	Yes	Fillable Fileable

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 12

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

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	12	0	12
Annual IC Time Burden (Hours)	32	2	30
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.