Information Collection

State, Local and Tribal Governments

IC 236492 under ICR 202503-3060-003 · OMB 3060-0895.

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Information Collection (IC) Details

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IC Title:	State, Local and Tribal Governments	Agency IC Tracking Number:	WCB

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 47 CFR 52.15

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: General Government

Subfunction: Central Fiscal Operations

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4,072	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 95 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	37,086	0	37,086
Annual IC Time Burden (Hours)	145,318	-1	145,319
Annual IC Cost Burden (Dollars)	2,679,515	305,765	2,373,750

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

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