Information Collection

Collection of Required Data Elements to Verify Eligibility

IC 218567 under ICR 201510-0704-002 · OMB 0704-0545.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0704-0545 can be found here:

Documents and Forms

Document Name Document Type
Screenshots.docx Other-Instrument Screen Shots
Dropdown List Screen - Reasons.pptx Other-Verificaiton Screen with Drop

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Collection of Required Data Elements to Verify Eligibility	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Verificaiton Screen with Drop Down List			Dropdown List Screen - Reasons.pptx		Yes	Yes	Fillable Fileable
Other-Instrument Screen Shots			Screenshots.docx		Yes	Yes	Fillable Fileable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records
Title: Personnel Security Breach Notification and Mitigation Services Records.	FR Citation: 80 FR 66883

Number of Respondents: 19,000,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	19,000,000	19,000,000
Annual IC Time Burden (Hours)	2,650,000	2,650,000
Annual IC Cost Burden (Dollars)	111,299,997	111,299,997

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.