Information Collection

Volunteer Participant Release of Liability Agreement

IC 221540 under ICR 201911-1670-004 · OMB 1670-0031.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1670-0031 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Volunteer Participant Release of Liability Agreement	Form and Instruction
Volunteer Participant Release of Liability Agreement CISA Form XXX_Volunteer Participant Release of Liability Agreement.pdf	Form and Instruction

IC Title:

Volunteer Participant Release of Liability Agreement

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:

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	n/a	Volunteer Participant Release of Liability Agreement	CISA Form XXX_Volunteer Participant Release of Liability Agreement.pdf		Yes	Yes	Fillable Fileable

Line of Business: Homeland Security

Subfunction: Key Asset and Critical Infrastructure Protection

Privacy Act System of Records

Title: DHS/ALL-002 - Department of Homeland Security (DHS) Mailing and Other Lists

FR Citation: 73 FR 71659

Number of Respondents: 750

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	750	0	750
Annual IC Time Burden (Hours)	75	-75	150
Annual IC Cost Burden (Dollars)	0	0	0

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.