Information Collection

Certification of Identity and Consent

IC 224051 under ICR 201610-1024-001 · OMB 1024-0280.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1024-0280 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 10-945 Certification of Identity and Consent	Form and Instruction
10-945 Certification of Identity and Consent Form 10-945 Certification of Identity and Consent10202016.docx	Form and Instruction

IC Title:

Certification of Identity and Consent

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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	10-945	Certification of Identity and Consent	Form 10-945 Certification of Identity and Consent10202016.docx		Yes	Yes	Fillable Printable

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records

Title: Privacy Act Files â Interior, DOI-57

FR Citation: 81 FR 45527

Number of Respondents: 2,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 20 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,000	2,000
Annual IC Time Burden (Hours)	100	100
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.