Information Collection

Medium Assessment

IC 243645 under ICR 202405-0750-002 · OMB 0750-0004.

Documents and Forms

Document Name Document Type
0750-0004 Collection Instrument.docx Other-Contract Clauses
0750-0004 Collection Instrument.docx Other-Contract Clauses

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Medium Assessment	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 48 CFR 204 48 CFR 252

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Contract Clauses			0750-0004 Collection Instrument.docx		Yes	Yes	Fillable Fileable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 175	Number of Respondents for Small Entity: 52

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	175	-25	200
Annual IC Time Burden (Hours)	1,400	-200	1,600
Annual IC Cost Burden (Dollars)	122,780	-58,932	181,712

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.