Certification of Identity and Consent

Certification of Identity and Consent Form

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1024-0280 can be found here:

Documents and Forms

Document Name Document Type
Form 10-945 Certification of Identity and Consent Form and Instruction
10-945 Certification of Identity and Consent Form 10-945 Certification of Identity and Consent 11.4.2019.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Certification of Identity and Consent	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	10-945	Certification of Identity and Consent	Form 10-945 Certification of Identity and Consent 11.4.2019.docx		Yes	Yes	Fillable Printable

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records
Title: Privacy Act Files – Interior, DOI-57	FR Citation: 81 FR 45527

Number of Respondents: 2,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 20 %

	Approved	Previously Approved
Annual Number of Responses for this IC	2,000	2,000
Annual IC Time Burden (Hours)	100	100
Annual IC Cost Burden (Dollars)	0	0

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.