Information Collection

DFARS Clause 252.204-7023

IC 211676 under ICR 202406-0704-009 · OMB 0704-0519.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
0704-0519 Collection Instrument.docx	Other-Contract Clause
0704-0519 Collection Instrument.docx	Other-Contract Clause

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 28 CFR 204

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
Other-Contract Clause					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: 1,895

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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	5,515	1,131	4,384
Annual IC Time Burden (Hours)	11,030	2,262	8,768
Annual IC Cost Burden (Dollars)	709,670	-20,880	730,550

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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