Information Collection

Request For Personal Identity Verification Card

IC 44129 under ICR 201412-2900-001 · OMB 2900-0673.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
ManagerPIVScreen.jpg vaww.piv.va.gov/idm/piv	Other-VA PIV Enrollment System Porta
SponsorPIVScreen.jpg vaww.piv.va.gov/idm/piv	Other-VA PIV Enrollment System Porta
Copy of Entry Page Registrar and Issuer.pdf vaww.piv.va.gov/idm/piv	Other-Snap shot

IC Title:

REQUEST FOR PERSONAL IDENTITY VERIFICATION CARD

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	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-VA PIV Enrollment System Portal	ManagerPIVScreen.jpg	https://vaww.piv.va.gov/idm/piv	Yes	Yes	Fillable Fileable Signable
Other-VA PIV Enrollment System Portal	SponsorPIVScreen.jpg	https://vaww.piv.va.gov/idm/piv	Yes	Yes	Fillable Fileable Signable
Other-Snap shot	Copy of Entry Page Registrar and Issuer.pdf	https://vaww.piv.va.gov/idm/piv	Yes	Yes	Fillable Fileable

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 100,000

Number of Respondents for Small Entity: 0

Affected Public: Federal Government

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	100,000	100,000
Annual IC Time Burden (Hours)	8,333	8,333
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.