Information Collection Request

FOCI Outside Director/Proxy Holder

ICR 201910-0705-001 · OMB 0705-0005 · Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
0740-ODPH_SSA_10.23.2019 (002).docx Supporting Statement A Uploaded 2019-10-25 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
238280 Group Assessment Form Other-null New
238279 Peer Evaluation Form Other-null New
238275 Self-Assessment Form Other-null New
238273 Outside Director/Proxy Holder Nominee Package and Nominating Official Package Other-null New

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
12/31/2022 36 Months From Approved
9,875 0 0
7,494 0 0
998,567 0 0





Reginfo record details
4
table that charts list of burden
IC Title Form No. Form Name
Self-Assessment Form
Group Assessment Form
Outside Director/Proxy Holder Nominee Package and Nominating Official Package
Peer Evaluation Form

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 9,875 0 0 9,875 0 0
Annual Time Burden (Hours) 7,494 0 0 7,494 0 0
Annual Cost Burden (Dollars) 998,567 0 0 998,567 0 0


Reginfo record details
  No