Individuals and Households

Donor Certification Form

Documents and Forms

Document Name Document Type
Form DI-3680 Individuals and Households Form
DI-3680 Donor Certification Form DOI Donor Certification Form DI-3680 10-22-18.docx Form
DI-3680 Donor Certification Form DOI Donor Certification Form DI-3680 10-22-18.docx Form

Information Collection (IC) Details

IC Title:	Individuals and Households	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	DI-3680	Donor Certification Form	DOI Donor Certification Form DI-3680 10-22-18.docx		Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Central Property Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 100	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 33 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	100	50	50
Annual IC Time Burden (Hours)	33	16	17
Annual IC Cost Burden (Dollars)	0	0	0

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.