Information Collection

Potential Board Member Information

IC 35496 under ICR 202305-3240-001 · OMB 3240-0005.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 404 Potential Board Member Information	Form and Instruction
404 Potential Board Member Information SSS Form 404 Instruction Sheets and Form Nov 2019r.pdf	Form and Instruction
404 Potential Board Member Information SSS Form 404 Instruction Sheets and Form Nov 2019r.pdf	Form and Instruction
New SSS Form 404 Supporting Statement August 2023.docx Supporting Statement	IC Document
New SSS Form 404 Supporting Statement August 2023.docx Supporting Statement	IC Document

IC Title:

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
Form and Instruction	404	Potential Board Member Information	SSS Form 404 Instruction Sheets and Form Nov 2019r.pdf		No		Paper Only

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records

Title: Integrated Mobilization Information Management System (IMIS) and Reserve and National Guard Personnel Records.

FR Citation: 82 FR 29970

Number of Respondents: 900

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	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	900	900
Annual IC Time Burden (Hours)	225	225
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement	New SSS Form 404 Supporting Statement August 2023.docx	08/24/2023

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.