Information Collection

SBSE ACSI Questionnaire-20275-A5-2

IC 236489 under ICR 201805-1090-002 · OMB 1090-0007.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1090-0007 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 059-20275A5-2 SBSE ACSI Questionnaire-20275-A5-2	Form and Instruction
059-20275A5-2 SBSE ACSI Questionnaire 20275A5-2 2019 SBSE ACSI Questionnaire - DRAFT 5.22.19.docx	Form and Instruction
OMB Mapping Cover Template_2019_IRS SBSE.xlsx OMB Mapping Cover for SBSE Survey	IC Document
Generic Clearance Request Form IRS SBSE_IA 20275 A5-2-Signed.pdf Generic Clearance Request form	IC Document

IC Title:

SBSE ACSI Questionnaire-20275-A5-2

Agency IC Tracking Number:

059-20275A5-2

IC Status: New

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	059-20275A5-2	SBSE ACSI Questionnaire 20275A5-2	2019 SBSE ACSI Questionnaire - DRAFT 5.22.19.docx		Yes	Yes	Fillable Printable

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 250

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	250	250
Annual IC Time Burden (Hours)	50	50
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
OMB Mapping Cover for SBSE Survey	OMB Mapping Cover Template_2019_IRS SBSE.xlsx	06/13/2019
Generic Clearance Request form	Generic Clearance Request Form IRS SBSE_IA 20275 A5-2-Signed.pdf	06/13/2019

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