Information Collection

Applicants

IC 206961 under ICR 201909-2528-001 · OMB 2528-0297.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2528-0297 can be found here:

Documents and Forms

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.