Information Collection

Anomaly Reporting Form

IC 216195 under ICR 201504-3265-003 · OMB 3265-0019.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form EAC 003C Anomaly Reporting Form	Form
EAC 003C Anomaly Reporting Form Voting System Anomaly Reporting Form.EAC 003C.pdf www.eac.gov/testing_and_certification/anomaly_reporting_form.aspx	Form

IC Title:

Agency IC Tracking Number:

EAC 003C

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	EAC 003C	Anomaly Reporting Form	Voting System Anomaly Reporting Form.EAC 003C.pdf	http://www.eac.gov/testing_and_certification/anomaly_reporting_form.aspx	Yes	Yes	Fillable Fileable Signable

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 41

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

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	41	41
Annual IC Time Burden (Hours)	82	82
Annual IC Cost Burden (Dollars)	1,025	1,025

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.