Certification of Identity Form

Freedom of Information/Privacy Act Record Request Form

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

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:

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 %

	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

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.