Information Collection

Individuals or Households

IC 238054 under ICR 202212-3060-011 · OMB 3060-1267.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3060-1267 can be found here:

Documents and Forms

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

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.