Information Collection

Individuals or Households

IC 251168 under ICR 202201-3060-005 · OMB 3060-1298.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3060-1298 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form FCC Form A-384 Individuals or Households	Form and Instruction
FCC Form A-384 Volunteer Service Agreement A-384-Volunteer Service Agreement new version v2 January 2022.docx	Form and Instruction
FCC Form A-384 Volunteer Service Agreement A-384-Volunteer Service Agreement new version v2 January 2022.docx	Form and Instruction

IC Title:

Individuals or Households

Agency IC Tracking Number:

OMD-IO

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 47 CFR 19.735-203 47 CFR 2635

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	FCC Form A-384	Volunteer Service Agreement	A-384-Volunteer Service Agreement new version v2 January 2022.docx		Yes	Yes	Fillable Printable

Line of Business: General Government

Subfunction: Central Fiscal Operations

Privacy Act System of Records

Title: FCC/OMD-16, Personnel Security Files

FR Citation: 86 FR 50349

Number of Respondents: 25

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	25	25
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.