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Federal forms, ICRs, and supporting documents

Information Collection

DI-4017, Consent for Disclosure of Records Protected under the Privacy Act

IC 256548 under ICR 202504-1093-001 · OMB 1093-0013.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

DI-4017, Consent for Disclosure of Records Protected under the Privacy Act
 
No Unchanged
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction DI-4017 CONSENT FOR DISCLOSURE OF RECORDS PROTECTED UNDER THE PRIVACY ACT DI-4017 Consent for Disclosure of Records Protected Under the Privacy Act_508 and Fillable_FINAL (2).pdf Yes Yes Fillable Fileable

General Government Central Records & Statistical Mgt

FWS-5 - National Wildlife Refuge Special Use Permits-Interior  73 FR 31877

1,190 0
   
Individuals or Households
 
   100 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 1,190 0 0 0 0 1,190
Annual IC Time Burden (Hours) 298 0 0 0 0 298
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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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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