Information Collection

Commercial and Public Safety Interference Complaint Intake Form, FCC-5624

IC 226378 under ICR 201704-3060-012 · OMB 3060-1230.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3060-1230 can be found here:

Documents and Forms

Document Name Document Type
FCC Form 5624 Annex A to Supporting Statement.docx Other-Screen Shots - Portal

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Commercial and Public Safety Interference Complaint Intake Form, FCC-5624	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Screen Shots - Portal			FCC Form 5624 Annex A to Supporting Statement.docx		Yes	Yes	Fillable Fileable Signable

Line of Business: General Government

Subfunction: Central Fiscal Operations

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 500	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	500	500
Annual IC Time Burden (Hours)	250	250
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.