Information Collection

Withdrawal Questionnaire

IC 260529 under ICR 202306-0625-002 · OMB 0625-0280.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0625-0280 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Withdrawal Questionnaire	Form and Instruction
Withdrawal Questionnaire instr_DPF withdrawal qnr_06-01-23_clean.pdf	Form and Instruction
Withdrawal Questionnaire instr_DPF withdrawal qnr_06-01-23_clean.pdf	Form and Instruction

IC Title:

Withdrawal Questionnaire

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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	N/A	Withdrawal Questionnaire	instr_DPF withdrawal qnr_06-01-23_clean.pdf		Yes	Yes	Fillable Fileable

Line of Business: International Affairs and Commerce

Subfunction: Global Trade

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 300

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	300	300
Annual IC Time Burden (Hours)	100	100
Annual IC Cost Burden (Dollars)	7,020	7,020

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.