Information Collection

Functional Abilities Evaluation Form

IC 224325 under ICR 201808-0420-004 · OMB 0420-0550.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form PC-262-15 Functional Abilities Evaluation Form	Form and Instruction
PC-262-15 Functional Abilities Evaluation Form Functional_Abilities_Evaluation.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

PC-262-15

IC Status: Unchanged

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	PC-262-15	Functional Abilities Evaluation Form	Functional_Abilities_Evaluation.docx		Yes	No	Fillable Printable

Line of Business: International Affairs and Commerce

Subfunction: International Development and Humanitarian Aid

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 300

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	300	300
Annual IC Time Burden (Hours)	225	225
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.