Self-Assessment Form

FOCI Outside Director/Proxy Holder

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0705-0005 can be found here:

Documents and Forms

Document Name Document Type
FOCI Board Self Assessment Form (Aug 8 2019).pdf Other-null

Information Collection (IC) Details

IC Title:	Self-Assessment Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-null			FOCI Board Self Assessment Form (Aug 8 2019).pdf		Yes	Yes	Fillable Fileable Signable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,400	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,400	1,400
Annual IC Time Burden (Hours)	1,050	1,050
Annual IC Cost Burden (Dollars)	139,916	139,916

Documents for IC

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.