Information Collection

Application for Domestic Indemnification

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

Documents and Forms

Documents and forms in this information collection
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

IC Title:

Agency IC Tracking Number:

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 45 CFR 201

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 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 %

table that charts list of burden
	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

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.