Information Collection

Collection of Required Data Elements to Verify Eligibility

IC 218567 under ICR 201512-0704-004 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
opmv_ctry-dp_screen-shot_Inside the US.PNG	Other-Screen Shot-Address is inside
opmv_ctry-dp_screen-shot_Outside the US.PNG	Other-Screen Shot - Addess is outsid

IC Title:

Collection of Required Data Elements to Verify Eligibility

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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
Other-Screen Shot-Address is inside the US			opmv_ctry-dp_screen-shot_Inside the US.PNG		Yes	Yes	Fillable Fileable
Other-Screen Shot - Addess is outside the US			opmv_ctry-dp_screen-shot_Outside the US.PNG		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 %

table that charts list of burden
	Approved	Previously Approved
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

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.