Information Collection

Certification and Release of Records

IC 244631 under ICR 202308-1125-001 · OMB 1125-0017.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1125-0017 Certification and Release of Records	Form and Instruction
Form 1125-0017 Certification and Release of Records Certification and Release of Records	Form and Instruction
1125-0017 Certification and Release of Records Form EOIR 59-Cert Release_Proposed Changes_v3-clean.docx	Form and Instruction
1125-0017 Certification and Release of Records Form EOIR 59-Cert Release_Proposed Changes_v3-clean.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

EOIR-59

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	1125-0017				Yes	Yes	Fillable Printable

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records

Title: Records and Management Information System

FR Citation: 72 FR 3410

Number of Respondents: 55,475

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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	55,475	4,879	50,596
Annual IC Time Burden (Hours)	9,246	9,246	0
Annual IC Cost Burden (Dollars)	0	0	0

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.

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