Information Collection

e2569 Module

IC 256564 under ICR 202305-0720-001 · OMB 0720-0055.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
e2569 Module_2022.pdf	Other-Screenshots
e2569 Module_2022.pdf	Other-Screenshots

IC Title:

e2569 Module

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

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
Other-Screenshots			e2569 Module_2022.pdf		Yes	Yes	Fillable Fileable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,428,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	2,142,000	-177,000	2,319,000
Annual IC Time Burden (Hours)	142,800	-11,800	154,600
Annual IC Cost Burden (Dollars)	4,733,820	-159,270	4,893,090

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.