Information Collection

Standard Assurance Form

IC 205263 under ICR 201907-1121-004 · OMB 1121-0140.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Standard Assurance Standard Assurance Form	Form
Standard Assurance OJP_Standard_Assurances.docx	Form

IC Title:

Agency IC Tracking Number:

OGC

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

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	none			n/a	Yes	No	Printable Only

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 8,250

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	8,250	8,250
Annual IC Time Burden (Hours)	2,750	2,750
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.

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