Information Collection

Assessments Service Request Form

IC 270340 under ICR 202408-1670-001 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Assessments Service Request Form	Form and Instruction
Assessments Service Request Form 24-05940c - 1670-NEW-SRF for EAS_3_30-day FRN_Form A_v1.pdf	Form and Instruction

IC Title:

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
Form and Instruction	NA	Assessments Service Request Form	24-05940c - 1670-NEW-SRF for EAS_3_30-day FRN_Form A_v1.pdf		Yes	Yes	Fillable Fileable

Line of Business: Homeland Security

Subfunction: Key Asset and Critical Infrastructure Protection

Privacy Act System of Records

Title: DHS/ALL-002 Department of Homeland Security (DHS) Mailing and Other List Systems

FR Citation: 73 FR 71659

Number of Respondents: 5,000

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	7,500	7,500
Annual IC Time Burden (Hours)	825	825
Annual IC Cost Burden (Dollars)	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.