Information Collection

Annuitant Pledge Form

IC 228913 under ICR 202009-3206-004 · OMB 3206-0271.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
508 2020 CFC Retiree Pledge Form ICR 3206 0271.pdf CFC Pledge Form	IC Document
508 2020 CFC Retiree Pledge Form ICR 3206 0271.pdf CFC Pledge Form	IC Document
CFC Donor Pledging System Screen Shots 2020.pdf CFC Donor Pledge System Screen Shots	IC Document
CFC Donor Pledging System Screen Shots 2020.pdf CFC Donor Pledge System Screen Shots	IC Document

IC Title:

Agency IC Tracking Number:

OPM 1654B

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 5 CFR 950

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

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title: Combined Federal Campaign Annunitnt Pledge

FR Citation: 85 FR 42444

Number of Respondents: 250,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 80 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	250,000	0	250,000
Annual IC Time Burden (Hours)	125,000	0	125,000
Annual IC Cost Burden (Dollars)	408,175	408,175	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
CFC Pledge Form	508 2020 CFC Retiree Pledge Form ICR 3206 0271.pdf	09/28/2020
CFC Donor Pledge System Screen Shots	CFC Donor Pledging System Screen Shots 2020.pdf	09/28/2020

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