Impact Assessment Questionnaire: COVID-19 Response Version

Impact Assessment Questionnaire

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3015-0009 can be found here:

Documents and Forms

Document Name Document Type
Form DFC-007a Impact Assessment Questionnaire: COVID-19 Response Version Form and Instruction
DFC-007a Impact Assessment Questionnaire: COVID-19 Response Versi DFC-007a COVID-19 Response Version.xlsm Form and Instruction

Information Collection (IC) Details

IC Title:	Impact Assessment Questionnaire: COVID-19 Response Version	Agency IC Tracking Number:	DFC-007a

Is this a Common Form? No		IC Status: New

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	DFC-007a	Impact Assessment Questionnaire: COVID-19 Response Version	DFC-007a COVID-19 Response Version.xlsm		Yes	Yes	Fillable Fileable

Line of Business: International Affairs and Commerce

Subfunction: International Development and Humanitarian Aid

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 25	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	25	25
Annual IC Time Burden (Hours)	70	70
Annual IC Cost Burden (Dollars)	5,250	5,250

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.