Information Collection

Signature Card

IC 214064 under ICR 201601-1405-003 · OMB 1405-0105.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1405-0105 can be found here:

Documents and Forms

Document Name Document Type
Form DS-4139 SIGNATURE CARD Form
DS-4139 SIGNATURE CARD DS-4139 (11-2014).pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	SIGNATURE CARD	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

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
Form	DS-4139	SIGNATURE CARD	DS-4139 (11-2014).pdf		Yes	Yes	Fillable Fileable

Line of Business: International Affairs and Commerce

Subfunction: Foreign Affairs

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,121	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	7,245	7,245
Annual IC Time Burden (Hours)	604	604
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.