Information Collection

Incident Reporting Form

IC 228877 under ICR 201710-1670-003 · OMB 1670-0037.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1670-0037 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Incident Reporting Form	Form and Instruction
Incident Reporting Form Incident Reporting Form.docx	Form and Instruction

IC Title:

Incident Reporting Form

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

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	n/a	Incident Reporting Form	Incident Reporting Form.docx		Yes	Yes	Fillable Fileable

Line of Business: Homeland Security

Subfunction: Key Asset and Critical Infrastructure Protection

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 22,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	22,000	22,000
Annual IC Time Burden (Hours)	1,100	1,100
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.