USVSST Application

United States Victims of State Sponsored Terrorism Fund Application

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1123-0013 can be found here:

Documents and Forms

Document Name Document Type
1123-NEW_APPLICATION FORM DRAFT 7.14.16 3 pm.docx www.usvsst.com Other-Application Form

Information Collection (IC) Details

IC Title:	USVSST Application	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 42 CFR 10609

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Application Form			1123-NEW_APPLICATION FORM DRAFT 7.14.16 3 pm.docx	http://www.usvsst.com	Yes	Yes	Fillable Fileable

Line of Business: Disaster Management

Subfunction: Disaster Repair and Restore

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,200	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,200	1,200
Annual IC Time Burden (Hours)	2,400	2,400
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.