Information Collection

Input Form

IC 214351 under ICR 201804-1084-001 · OMB 1084-0034.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1084-0034 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Input Form	Form and Instruction
INPUT ON COLLECTIONS FROM LANDS ADMINISTERED BY THE DEPA Input Form - REVISED 5-18-15 Final.pdf www.surveygizmo.com/s3/1934156/DOI-Input-on-Collections-Form	Form and Instruction

IC Title:

Input Form

Agency IC Tracking Number:

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 and Instruction	None	INPUT ON COLLECTIONS FROM LANDS ADMINISTERED BY THE DEPARTMENT OF THE INTERIOR THAT ARE LOCATED AT NON-FEDERAL FACILITIES	Input Form - REVISED 5-18-15 Final.pdf	http://www.surveygizmo.com/s3/1934156/DOI-Input-on-Collections-Form	Yes	Yes	Fillable Fileable

Line of Business: Education

Subfunction: Cultural and Historic Preservation

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, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	100	-100	200
Annual IC Time Burden (Hours)	1,200	200	1,000
Annual IC Cost Burden (Dollars)	0	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.