Information Collection

Checklist

IC 214350 under ICR 201412-1084-001 · OMB 1084-0034.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1084-0034 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Checklist	Form and Instruction
FACILITY CHECKLIST FOR SPACES HOUSING DOI MUSEUM PROPERT DOI Museum Checklist for Non-DOI Facilities - REVISED 5-18-2015.docx	Form and Instruction

IC Title:

Checklist

Agency IC Tracking Number:

Is this a Common Form? No

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	None	FACILITY CHECKLIST FOR SPACES HOUSING DOI MUSEUM PROPERTY (NON-DOI FACILITIES)	DOI Museum Checklist for Non-DOI Facilities - REVISED 5-18-2015.docx		Yes	Yes	Fillable Fileable

Line of Business: Education

Subfunction: Cultural and Historic Preservation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 100

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 75 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	200	200
Annual IC Cost Burden (Dollars)	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.