Information Collection

Incident Report Form

IC 210253 under ICR 201903-0704-003 · OMB 0704-0514.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0704-0514 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Defense Logistics Agency Log in Screen 4.19.2019.docx	Other-DLA Police Center Records Logi
DLA_POLC_RMS_Application_Images.pdf	Other-Police Center Records System S
DLA 635 Incident Report DRAFT - DL0635.pdf	Form and Instruction

IC Title:

Incident Report Form

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Police Center Records System Screenshots			DLA_POLC_RMS_Application_Images.pdf	Yes	Yes	Fillable Fileable
Other-DLA Police Center Records Login Page			Defense Logistics Agency Log in Screen 4.19.2019.docx	Yes	Yes	Fillable Fileable
Form and Instruction	DLA 635	Incident Report	DRAFT - DL0635.pdf	Yes	Yes	Fillable Fileable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 75 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	2,000	1,780	220
Annual IC Time Burden (Hours)	1,000	890	110
Annual IC Cost Burden (Dollars)	26,000	22,792	3,208

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.