Information Collection

EX Signature Block Survey

IC 259679 under ICR 202112-1405-002 · OMB 1405-0193.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1405-0193 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
EX Signature Block Survey EX Signature Block Survey	Form and Instruction
EX Signature Block Survey EX Signature Block Survey (2).pdf	Form and Instruction
2023.04.04 DS-4183 - Signature Line Survey Request.pdf DS-4183	IC Document

IC Title:

EX Signature Block Survey

Agency IC Tracking Number:

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	NA				Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 10

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	10	10
Annual IC Time Burden (Hours)	1	1
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
DS-4183		04/13/2023

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

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