Individuals or Households

FCC Anti-Harassment Intake Form

Documents and Forms

Document Name Document Type
Form FCC Form 5632 Individuals or Households Form
FCC Form 5632 FCC Anti-Harassment Intake Form Anti-Harassment Intake Form draft.docx Form

Information Collection (IC) Details

IC Title:	Individuals or Households	Agency IC Tracking Number:	OMD

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 29 CFR 1604.11(f)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	FCC Form 5632	FCC Anti-Harassment Intake Form	Anti-Harassment Intake Form draft.docx		No		Paper Only

Line of Business: General Government

Subfunction: Central Fiscal Operations

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	2	0	-3	5
Annual IC Time Burden (Hours)	9	1	-10	18
Annual IC Cost Burden (Dollars)	2,025	0	-2,025	4,050

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.