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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Privacy Act Request Form	Form
Privacy Act Request Form privacy-act-request.pdf	Form

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:

table that charts list of 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 %

table that charts list of burden
	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

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.