Information Collection

Records Modification Form (FD-1115)

IC 215286 under ICR 201502-1110-006 · OMB 1110-0068.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1110-0068 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form FD-1115 Records Modification Form (FD-1115)	Form
FD-1115 Records Modification Form FD-1115_form.pdf	Form
FD-1115 Records Modification Form FD-1115_form.pdf	Form

IC Title:

Records Modification Form (FD-1115)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 28 CFR 20.33 28 CFR 0.85 28 CFR 50.12

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	FD-1115	Records Modification Form	FD-1115_form.pdf		No		Fillable Fileable
Form	FD-1115	Records Modification Form	FD-1115_form.pdf		No		Fillable Fileable

Line of Business: Law Enforcement

Subfunction: Criminal Investigation and Surveillance

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 152,430

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	132,070	132,070
Annual IC Time Burden (Hours)	22,011	22,011
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.