Information Collection

Request for Use of NETC Facilities

IC 21089 under ICR 202011-1660-003 · OMB 1660-0029.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1660-0029 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 119-17-2 Request for Use of NETC Facilities	Form
119-17-2 Request For Use of NETC Facilities 119-17-2.pdf	Form
119-17-2 Request For Use of NETC Facilities 119-17-2.pdf	Form

IC Title:

Request for Use of NETC Facilities

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 44 CFR Part 15 (To search for a specific CFR, visit the Code of Federal Regulations.)

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	119-17-2	Request For Use of NETC Facilities	119-17-2.pdf		Yes	Yes	Printable Only

Line of Business: Disaster Management

Subfunction: Disaster Preparedness and Planning

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 60

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	60	60
Annual IC Time Burden (Hours)	6	6
Annual IC Cost Burden (Dollars)	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.