Information Collection

Request for an Extension

IC 191774 under ICR 201704-1670-001 · OMB 1670-0014.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1670-0014 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form DHS Form 9036 Request for an Extension	Form and Instruction
Request for Extension Screenshots.pdf	Other-screenshots
DHS Form 9036 Request for An Extension Request for Extention_1 Aug 2017.docx	Form and Instruction

IC Title:

Request for an Extension

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	DHS Form 9036	Request for An Extension	Request for Extention_1 Aug 2017.docx		Yes	Yes	Fillable Fileable
Other-screenshots			Request for Extension Screenshots.pdf		Yes	Yes	Fillable Fileable

Line of Business: Homeland Security

Subfunction: Key Asset and Critical Infrastructure Protection

Privacy Act System of Records

Title: Mailing and Other Lists System

FR Citation: 73 FR 71659

Number of Respondents: 730

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	730	-1,145	1,875
Annual IC Time Burden (Hours)	58	-411	469
Annual IC Cost Burden (Dollars)	0	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.