Information Collection

Identification and Privilege Card Application

IC 219006 under ICR 201812-0702-001 · OMB 0702-0129.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0702-0129 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Exchange Form 1100 Identification and Privilege Card Application	Form
Exchange Form 1100 Identification & Privilege Card Application FORM 1100-016.PDF	Form

IC Title:

Identification and Privilege Card Application

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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	Exchange Form 1100-016	Identification & Privilege Card Application	FORM 1100-016.PDF		No		Paper Only

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,500

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	2,500	2,500
Annual IC Time Burden (Hours)	625	625
Annual IC Cost Burden (Dollars)	4,525	4,525

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.