Information Collection

Records Modification Form (FD-1115)

IC 215286 under ICR 202111-1110-001 · OMB 1110-0068.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form FD-1115 Records Modification Form (FD-1115)	Form and Instruction
FD-1115 FBI Modification Form FD-1115 Form.docx	Form and Instruction
FD-1115 FBI Modification Form FD-1115 Form.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 28 CFR 50.12 28 CFR 0.85 28 CFR 20.33

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	FD-1115	FBI Modification Form	FD-1115 Form.docx		Yes	Yes	Fillable Fileable

Line of Business: Law Enforcement

Subfunction: Criminal Investigation and Surveillance

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 105

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 97 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	79,756	-39,537	119,293
Annual IC Time Burden (Hours)	6,646	-13,236	19,882
Annual IC Cost Burden (Dollars)	0	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.