Applicants

License for the Use of Personally Identifiable Information Protected Under the E-Government Act of 2002, Title V and the Privacy Act of 1974

Documents and Forms

Document Name Document Type
Affidavit of Nondisclosure 2020.docx Other-Affidavit of Nondisclosure
Data License Application 2020.docx Other-Data License Application
PDR License Agreement 2019 (For Web) Revised with DL Number line-Blank.docx Other-PDR License Agreement
Data File Destruction Form 2020.docx Data File Destruction Form 2020 IC Document

Information Collection (IC) Details

IC Title:	Applicants	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Electronic Capability
Other-PDR License Agreement	PDR License Agreement 2019 (For Web) Revised with DL Number line-Blank.docx	No	Paper Only
Other-Affidavit of Nondisclosure	Affidavit of Nondisclosure 2020.docx	No	Paper Only
Other-Data License Application	Data License Application 2020.docx	No	Paper Only

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 15	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	15	3	12
Annual IC Time Burden (Hours)	15	3	12
Annual IC Cost Burden (Dollars)	750	150	600

Documents for IC

Title	Document	Date Uploaded
Data File Destruction Form 2020	Data File Destruction Form 2020.docx	01/16/2020

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