Information Collection

Potential Board Member Information

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

Documents and Forms

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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Potential Board Member Information	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection 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 %

	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

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.