Information Collection Request
Eligibility Questionnaire for HAVANA Act Payments
ICR 202211-1405-004 · OMB 1405-0250 · Received in OIRA
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 1405-0250 can be found here:
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form DS-4316 Eligibility Questionnaire For HAVANA Act Payments |
Form and Instruction | Modified | Repair queued |
 ds4316 Aug 2022.pdf |
Supplementary Document | Uploaded 2022-11-21 | Repair queued |
 Legal Authorities -30-day HAVANA Act PRA.docx |
Supplementary Document | Uploaded 2022-11-21 | Repair queued |
| 30-day Supporting Statement -- HAVANA Act 1405-0250.docx |
Supporting Statement A | Uploaded 2022-11-21 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 253057 |  Eligibility Questionnaire For HAVANA Act Payments |
Form and Instruction | Modified |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | STATE/AFA |
| OMB Control No | 1405-0250 |
| Type of Information Collection | Revision of a currently approved collection |
| Previous ICR Reference No | 202208-1405-003 |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |