Information Collection

Privacy Act Request Form

IC 230996 under ICR 201804-1880-001 · OMB 1880-0546.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1880-0546 can be found here:

Documents and Forms

Document Name Document Type
Privacy Act Request Form Form
Privacy Act Request Form privacy-act-request.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Privacy Act Request Form	Agency IC Tracking Number:	ED-2017-ICCD-0162

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	N/A	Privacy Act Request Form	privacy-act-request.pdf		Yes	Yes	Fillable Fileable

Line of Business: Education

Subfunction: Elementary, Secondary, and Vocational Education

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 130	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	130	130
Annual IC Time Burden (Hours)	65	65
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.