Information Collection

Sequestered Juror Information Form

IC 203434 under ICR 202504-1105-002 · OMB 1105-0096.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form USM-523A Sequestered Juror Information Form Sequestered Juror Information Form	Form and Instruction
USM-523A Sequestered Juror Information Form usm523a_reinstatement without change_2026.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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	USM-523A				Yes	No	Fillable Printable

Line of Business: Litigation and Judicial Activities

Subfunction: Legal Prosecution and Litigation

Privacy Act System of Records

Title: USM-011, Judicial Protection Information System

FR Citation: 82 FR 24151

Number of Respondents: 14

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	14	14
Annual IC Time Burden (Hours)	1	1
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.

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