Information Collection

Technical Assistance (TA) Request Form

IC 221916 under ICR 201402-0690-001 · OMB 0690-0030.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0690-0030 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Technical Assistance (TA) Request Form	Form and Instruction
Technical Assistance (TA0 Request Form Fast Track Technical Assistance Request Form 6-9-16.docx	Form and Instruction
Customer Feedback Survey Fast Track Customer Feedback Survey 6-9-16.docx	Form and Instruction
0690-0030 NTIA Fast Track Generic Clearance Request 6-9-16_060316.docx Technical Assistance (TA Request Form	IC Document

IC Title:

Technical Assistance (TA) Request Form

Agency IC Tracking Number:

IC Status: New

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
Form and Instruction	NA	Technical Assistance (TA0 Request Form	Fast Track Technical Assistance Request Form 6-9-16.docx		Yes	Yes	Fillable Fileable
Form and Instruction	NA	Customer Feedback Survey	Fast Track Customer Feedback Survey 6-9-16.docx		Yes	Yes	Fillable Fileable

Line of Business: Economic Development

Subfunction: Business and Industry Development

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 300

Number of Respondents for Small Entity: 20

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
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
Technical Assistance (TA Request Form	0690-0030 NTIA Fast Track Generic Clearance Request 6-9-16_060316.docx	06/14/2016

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