Information Collection

Form and Instruction

IC 210117 under ICR 201401-0704-005 · OMB 0704-0516.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0704-0516 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form DDX656 Form and Instruction	Form and Instruction
DDX656 BASIC CRIMINAL HISTORY AND STATEMENT OF ADMISSION ddx656 - FINAL (5-6-14).pdf	Form and Instruction

IC Title:

Form and Instruction

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 32 CFR 79

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	DDX656	BASIC CRIMINAL HISTORY AND STATEMENT OF ADMISSION	ddx656 - FINAL (5-6-14).pdf		Yes	Yes	Fillable Fileable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 5,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 27 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	5,000	5,000
Annual IC Time Burden (Hours)	833	833
Annual IC Cost Burden (Dollars)	6,050	6,050

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.