Information Collection

Affidavit in Lieu of Lost Receipt of United States ICE for Collateral Accepted As Security

IC 189511 under ICR 201512-1653-003 · OMB 1653-0045.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1653-0045 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form I-395 Affidavit in Lieu of Lost Receipt of United States ICE for Collateral Accepted As Security	Form and Instruction
I-395 Affidavit in Lieu of Lost Receipt of United States ICE f ICE Form I-395.pdf	Form and Instruction

IC Title:

Affidavit in Lieu of Lost Receipt of United States ICE for Collateral Accepted As Security

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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 and Instruction	I-395	Affidavit in Lieu of Lost Receipt of United States ICE for Collateral Accepted As Security	ICE Form I-395.pdf		Yes	No	Fillable Printable

Line of Business: Homeland Security

Subfunction: Border and Transportation Security

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 12,500

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	12,500	0	12,500
Annual IC Time Burden (Hours)	6,250	0	6,250
Annual IC Cost Burden (Dollars)	87,500	87,500	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.