Information Collection

Personal Financial Statement

IC 213862 under ICR 201411-3420-003 · OMB 3420-0035.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3420-0035 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form OPIC-254 Personal Financial Statement	Form
OPIC-254 Personal Financial Statement OPIC 254 - Personal Financial Statement Form [FINAL 150108].docx	Form
OPIC 254 - 83 I_signed.pdf I-83	IC Document

IC Title:

Personal Financial Statement

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 22 CFR 706

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	OPIC-254	Personal Financial Statement	OPIC 254 - Personal Financial Statement Form [FINAL 150108].docx		Yes	Yes	Fillable Fileable Signable

Line of Business: International Affairs and Commerce

Subfunction: International Development and Humanitarian Aid

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 75

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

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	75	75
Annual IC Time Burden (Hours)	75	75
Annual IC Cost Burden (Dollars)	5,625	5,625

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
I-83	OPIC 254 - 83 I_signed.pdf	11/13/2014

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