Information Collection

Substitute Confidential Employment and Financial Disclosure

IC 42238 under ICR 201405-3002-001 · OMB 3002-0003.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form ACUS Form 1W Substitute Confidential Employment and Financial Disclosure	Form
ACUS Form 1W Substitute Non-government Member Confidential Employment Financial Disclosure--Web Format 5-14-2014.pdf	Form
ACUS Form 1 Substitute Non-government Member Confidential Employment Member Financial Disclosure Form 5-1-2014.pdf	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

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	ACUS Form 1W	Substitute Non-government Member Confidential Employment and Financial Disclosure Report	Financial Disclosure--Web Format 5-14-2014.pdf		Yes	Yes	Fillable Fileable
Form	ACUS Form 1	Substitute Non-government Member Confidential Employment and Financial Disclosure Report	Member Financial Disclosure Form 5-1-2014.pdf		Yes	No	Printable Only

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 90

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 95 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	180	-270	450
Annual IC Time Burden (Hours)	45	-68	113
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.