Information Collection

Application for Domestic Indemnification

IC 246725 under ICR 202301-3135-002 · OMB 3135-0123.

Documents and Forms

Document Name Document Type
Form 3135-0123 Application for Domestic Indemnification Form and Instruction
3135-0123 Application for Domestic Indemnification Instructions - Domestic Indemnity 2023.pdf Form and Instruction
3135-0123 Application for Domestic Indemnification Instructions - Domestic Indemnity 2023.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Application for Domestic Indemnification	Agency IC Tracking Number:

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 45 CFR 201

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	3135-0123	Application for Domestic Indemnification	Instructions - Domestic Indemnity 2023.pdf		Yes	Yes	Printable Only

Line of Business: Education

Subfunction: Cultural and Historic Preservation

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 18	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Previously Approved
Annual Number of Responses for this IC	18	18
Annual IC Time Burden (Hours)	720	720
Annual IC Cost Burden (Dollars)	37,746	37,746

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.