Information Collection

Individuals or Households

IC 251168 under ICR 202205-3060-007 · 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⚠️ Notice: This information collection may be referencing outdated material.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 January 2022 FINAL revised May 18 CLEAN.docx	Form and Instruction

IC Title:

Individuals or Households

Agency IC Tracking Number:

OMD-IO

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 47 CFR 2635 47 CFR 19.735-203

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 January 2022 FINAL revised May 18 CLEAN.docx		Yes	Yes	Fillable Printable

Line of Business: General Government

Subfunction: Central Fiscal Operations

Privacy Act System of Records

Title: OPM/GOVT-1

FR Citation: 77 FR 73694

Number of Respondents: 140

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	140	115	25
Annual IC Time Burden (Hours)	35	29	6
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.