Information Collection

Impact Assessment Questionnaire

IC 236742 under ICR 202211-3015-001 · OMB 3015-0009.

Documents and Forms

Document Name Document Type
Form DFC-007 Impact Assessment Questionnaire Form and Instruction
DFC-007 Impact Assessment Questionnaire 221101 DFC-007New.docx Form and Instruction
DFC-007 Impact Assessment Questionnaire 221101 DFC-007New.docx Form and Instruction
DFC-007 DFC-007 with tracked changes 221104 DFC-007 with tracked changes.docx Form and Instruction
DFC-007 DFC-007 with tracked changes 221104 DFC-007 with tracked changes.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Impact Assessment Questionnaire	Agency IC Tracking Number:	DFCâ007

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	DFC-007	Impact Assessment Questionnaire	221101 DFC-007New.docx		Yes	Yes	Fillable Fileable Signable
Form and Instruction	DFC-007	DFC-007 with tracked changes	221104 DFC-007 with tracked changes.docx		Yes	Yes	Fillable Fileable Signable

Line of Business: International Affairs and Commerce

Subfunction: International Development and Humanitarian Aid

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 250	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	250	0	250
Annual IC Time Burden (Hours)	375	-250	625
Annual IC Cost Burden (Dollars)	15,123	590	14,533

Documents for IC

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.