Information Collection

Freedom of Information/Privcy Act Request

IC 21021 under ICR 201703-1615-002 · OMB 1615-0102.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1615-0102 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form G-639 Freedom of Information/Privcy Act Request	Form
G639-INS-30Day-02282017.pdf	Instruction
G-639 Freedom of Information/Privacy Act Request G639-FRM-30Day-02282017.pdf	Form

IC Title:

Freedom of Information/Privcy Act Request

Agency IC Tracking Number:

G-639

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 8 CFR 103

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	G-639	Freedom of Information/Privacy Act Request	G639-FRM-30Day-02282017.pdf		Yes	No	Fillable Printable
Instruction			G639-INS-30Day-02282017.pdf		Yes	No	Printable Only

Line of Business: Homeland Security

Subfunction: Border and Transportation Security

Privacy Act System of Records

Title: FOIA/PA Records

FR Citation: 79 FR 6609

Number of Respondents: 163,000

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	163,000	21,000	142,000
Annual IC Time Burden (Hours)	40,750	5,250	35,500
Annual IC Cost Burden (Dollars)	859,450	326,950	532,500

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.