Information Collection

International Terrorism Victim Expense Reimbursement Program

IC 192597 under ICR 201712-1121-003 · OMB 1121-0309.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1121-0309 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
International Terrorism Victim Expense Reimbursement Program	Form
ITVERP Application Supplemental Sheets OMB 1121-0309 2017.docx	Other-supplemental sheets
ITVERP Claimant Satisfaction Tool 2017.docx	Other-satisfaction form
ITVERP application ITVERP Application OMB 1121-0309 2017.docx	Form

IC Title:

International Terrorism Victim Expense Reimbursement Program

Agency IC Tracking Number:

OVC

Is this a Common Form? No

IC Status: Modified

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	none	ITVERP application	ITVERP Application OMB 1121-0309 2017.docx	none	Yes	No	Fillable Printable
Other-supplemental sheets			ITVERP Application Supplemental Sheets OMB 1121-0309 2017.docx	none	Yes	No	Fillable Printable
Other-satisfaction form			ITVERP Claimant Satisfaction Tool 2017.docx	none	Yes	No	Fillable Printable

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: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	75	75
Annual IC Cost Burden (Dollars)	300	300

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.