Information Collection

Mapping and Questionnaire Documents IA 30669 A3 (Dept of Treasury)

IC 235027 under ICR 201805-1090-003 · OMB 1090-0008.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1090-0008 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 30669 Mapping and Questionnaire Documents IA 30669 A3 (Dept of Treasury)	Form and Instruction
30669 M3 MHA Questionnaire 12.17.15_DOT MHA Questionnaire 12.17.15_DOT.xlsx	Form and Instruction
30669 Q_TreasMha_Mobile_Browse_20170221 Q_TreasMha_Mobile_Browse_20170221.xlsx	Form and Instruction
1090-0008 Survey Mapping Document (OFS) IA 30669 A0_draft.xlsx 1090-0008 Survey Mapping Document (OFS) IA 30669 A0_draft	IC Document
Dept of Treasury OMB Form 11.13.2018 IA 30669 A3--.pdf Dept of Treasury OMB Form 11.13.2018 IA 30669 A3--	IC Document

IC Title:

Mapping and Questionnaire Documents IA 30669 A3 (Dept of Treasury)

Agency IC Tracking Number:

30669 A3

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	30669	Q_TreasMha_Mobile_Browse_20170221	Q_TreasMha_Mobile_Browse_20170221.xlsx		Yes	Yes	Fillable Fileable
Form and Instruction	30669 M3	MHA Questionnaire 12.17.15_DOT	MHA Questionnaire 12.17.15_DOT.xlsx		Yes	Yes	Fillable Fileable

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3,600

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	3,600	3,600
Annual IC Time Burden (Hours)	150	150
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
1090-0008 Survey Mapping Document (OFS) IA 30669 A0_draft	1090-0008 Survey Mapping Document (OFS) IA 30669 A0_draft.xlsx	02/21/2019
Dept of Treasury OMB Form 11.13.2018 IA 30669 A3--	Dept of Treasury OMB Form 11.13.2018 IA 30669 A3--.pdf	02/21/2019

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