Information Collection

Privacy Act Request Form

IC 263639 under ICR 202311-1894-004 · OMB 1894-0021.

Documents and Forms

Document Name Document Type
Privacy Act Request Form Form and Instruction
Privacy Act Request Form Privacy Act Request Form.pdf Form and Instruction
Privacy Act Request Form Privacy Act Request Form.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Privacy Act Request Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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	N/A	Privacy Act Request Form	Privacy Act Request Form.pdf		Yes	Yes	Fillable Fileable

Line of Business: Education

Subfunction: Elementary, Secondary, and Vocational Education

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 130	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	130	130
Annual IC Time Burden (Hours)	65	65
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.