Information Collection

Case Management Intake

IC 212081 under ICR 202501-0704-003 · OMB 0704-0528.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
0704-0528_CMS Screenshots_4.7.2025.docx	Other-Screenshots
0704-0528_CMS Screenshots_4.7.2025.docx	Other-Screenshots
0704-0528_ADN_2.27.2025.docx Agency Disclosure Notice	IC Document
0704-0528_ADN_2.27.2025.docx Agency Disclosure Notice	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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
Other-Screenshots					Yes	Yes	Fillable Fileable Signable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 242,711

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	242,711	22,988	219,723
Annual IC Time Burden (Hours)	242,711	22,988	219,723
Annual IC Cost Burden (Dollars)	1,759,655	1,361,956	397,699

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Agency Disclosure Notice		02/27/2025

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

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