Information Collection

Responsible Data Use Request Form

IC 251392 under ICR 202108-0414-001 · OMB 0414-0001.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form EP-002 Responsible Data Use Request Form	Form and Instruction
EP-002 Restricted Data User Request Form Restricted Data Use Request Form_Final.pdf Website is not yet live	Form and Instruction
EP-002 Restricted Data User Request Form Restricted Data Use Request Form_Final.pdf Website is not yet live	Form and Instruction
21-UFA04024-VDE RDUA_10-15-21_FINAL (1).pdf Restricted Data Use Agreement (RDUA)	IC Document
21-UFA04024-VDE RDUA_10-15-21_FINAL (1).pdf Restricted Data Use Agreement (RDUA)	IC Document

IC Title:

Agency IC Tracking Number:

EP-001

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

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	EP-002	Restricted Data User Request Form	Restricted Data Use Request Form_Final.pdf	Website is not yet live	Yes	Yes	Fillable Fileable Signable

Line of Business: Economic Development

Subfunction: Business and Industry Development

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 50

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	33	33
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Restricted Data Use Agreement (RDUA)	21-UFA04024-VDE RDUA_10-15-21_FINAL (1).pdf	02/01/2022

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