Records Modification Form (FD-1115)

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.