Information Collection

Addendum to 2020 Privacy and Confidentiality OMB Package

IC 243811 under ICR 201911-0607-007 · OMB 0607-0971.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0607-0971 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Addendum to 2020 Privacy and Confidentiality OMB Package	Form and Instruction
1 COVID Screening Statement Enclosure I COVID Screening Statement.docx	Form and Instruction
Addendum Memo_09282020.docx OMB Memo	IC Document
NOA.pdf Notice of Approval for Original Submission	IC Document

IC Title:

Addendum to 2020 Privacy and Confidentiality OMB Package

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

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
Form and Instruction	1	COVID Screening Statement	Enclosure I COVID Screening Statement.docx		No		Fillable Fileable

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1	1
Annual IC Time Burden (Hours)	0	0
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
OMB Memo	Addendum Memo_09282020.docx	09/30/2020
Notice of Approval for Original Submission	NOA.pdf	09/28/2020

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