Information Collection

Disclosure of Information related to Potential Violations

IC 182261 under ICR 201910-1405-005 · OMB 1405-0179.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1405-0179 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
DS-7787 Disclosure Form Instructions v3.14 2-25-2020.docx	Instruction
DS-7787 Disclosure of Information Related to Potential Violation DS-7787 Disclosure Form v3.14.pdf	Form

IC Title:

Disclosure of Information related to Potential Violations

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 22 CFR 120-130 (To search for a specific CFR, visit the Code of Federal Regulations.)

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
Instruction			DS-7787 Disclosure Form Instructions v3.14 2-25-2020.docx		Yes	Yes	Fillable Fileable
Form	DS-7787	Disclosure of Information Related to Potential Violations	DS-7787 Disclosure Form v3.14.pdf		Yes	Yes	Fillable Fileable

Line of Business: International Affairs and Commerce

Subfunction: Foreign Affairs

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 12,500

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	12,500	11,000	1,500
Annual IC Time Burden (Hours)	125,000	110,000	15,000
Annual IC Cost Burden (Dollars)	0	-52,500	52,500

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.