Information Collection

Claims of U.S. Nationals Referred to the Commission by the Department of State Pursuant to the International Claims Settlement Act of 1949, as Amended

IC 208579 under ICR 201602-1105-001 · OMB 1105-0100.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1105-0100 can be found here:

2019-11-26 - Extension without change of a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Claims of U.S. Nationals Referred to the Commission by the Department of State Pursuant to the International Claims Settlement Act of 1949, as Amended	Form and Instruction
Statement Claim Form 1105-0100_Referral Claim Form Final_091416.pdf	Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Claims of U.S. Nationals Referred to the Commission by the Department of State Pursuant to the International Claims Settlement Act of 1949, as Amended

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
Form and Instruction	None	Statement Claim Form	1105-0100_Referral Claim Form Final_091416.pdf		Yes	No	Fillable Printable

Federal Enterprise Architecture Business Reference Module

Line of Business: General Government

Subfunction: Legislative Functions

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 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	Previously Approved
Annual Number of Responses for this IC	500	500
Annual IC Time Burden (Hours)	1,000	1,000
Annual IC Cost Burden (Dollars)	0	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.