Information Collection

U.S. Effects Screening Questionnaire

IC 213878 under ICR 201711-3420-003 · OMB 3420-0036.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form OPIC-252 U.S. Effects Screening Questionnaire	Form and Instruction
OPIC-252 U.S. Effects Screening Questionnaire OPIC-252 - Form.pdf	Form and Instruction
OPIC-252 - Marked Changes.pdf OPIC-252 Changes	IC Document

IC Title:

Agency IC Tracking Number:

OPIC-252

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	OPIC-252	U.S. Effects Screening Questionnaire	OPIC-252 - Form.pdf		Yes	Yes	Fillable Fileable

Line of Business: International Affairs and Commerce

Subfunction: International Development and Humanitarian Aid

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 100

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Farms, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	100	-100	200
Annual IC Time Burden (Hours)	213	-387	600
Annual IC Cost Burden (Dollars)	15,938	938	15,000

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
OPIC-252 Changes	OPIC-252 - Marked Changes.pdf	11/28/2017

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