Information Collection

Eligibility Questionnaire For Havana Act Payments

IC 269584 under ICR 202407-0704-011 · OMB unassigned.

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IC Title:

ELIGIBILITY QUESTIONNAIRE FOR HAVANA ACT PAYMENTS

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

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 480

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	PreApproved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	480	480
Annual IC Time Burden (Hours)	240	240
Annual IC Cost Burden (Dollars)	19,439	19,439

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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.