Information Collection

Confidential Financial Disclosure Form - Individuals

IC 181374 under ICR 201408-2090-001 · OMB 2090-0029.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2090-0029 can be found here:

Documents and Forms

Document Name Document Type
Form 3110-48 Confidential Financial Disclosure Form - Individuals Form and Instruction
3110-48 Confidential Financial Disclosure Form for Special Gover EPA3110-48 expires 8-31-14.pdf www.epa.gov/hsrb/files/epa-3110-48-version-7-08.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Confidential Financial Disclosure Form - Individuals	Agency IC Tracking Number:	2260.05

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 40 CFR 5.2634

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	3110-48	Confidential Financial Disclosure Form for Special Government Employees	EPA3110-48 expires 8-31-14.pdf	http://www.epa.gov/hsrb/files/epa-3110-48-version-7-08.pdf	Yes	No	Fillable Printable

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 250	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	250	-50	300
Annual IC Time Burden (Hours)	250	-50	300
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.