Information Collection

Certification of Identity Form

IC 228906 under ICR 201711-0412-002 · OMB 0412-0589.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0412-0589 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 507-1 Certification of Identity Form	Form and Instruction
507-1 Certification of Identity 2017 New AID 507-1 Certification of Identity (7.21.2017).docx	Form and Instruction
2017 Supporting Statment for FOIA.docx Supporting Document	IC Document

IC Title:

Certification of Identity Form

Agency IC Tracking Number:

Is this a Common Form? Yes

IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 22 CFR 212.20

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	507-1	Certification of Identity	2017 New AID 507-1 Certification of Identity (7.21.2017).docx		Yes	Yes	Fillable Fileable

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records

Title: n/a

FR Citation: 82 FR 39

Number of Respondents: 300

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 90 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	300	300
Annual IC Time Burden (Hours)	150	150
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Document	2017 Supporting Statment for FOIA.docx	11/02/2017

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.