Information Collection

Application for Domestic Indemnification

IC 278895 under ICR 202601-3135-002 · OMB 3135-0094.

Documents and Forms

Document Name Document Type
Form 3135-0094 Application for Domestic Indemnification Application for Domestic Indemnification Form and Instruction
Indemnity Joint landing page Final.pdf Instruction
3135-0094 Application for Domestic Indemnification Domestic Indemnity Instructions Final.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Application for Domestic Indemnification	Agency IC Tracking Number:	3135NEA-Indemnity

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 45 CFR 201

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	3135-0094	Application for Domestic Indemnification	Domestic Indemnity Instructions Final.pdf		Yes	Yes	Fillable Fileable
Instruction			Indemnity Joint landing page Final.pdf		Yes	Yes	Printable Only

Line of Business: Education

Subfunction: Cultural and Historic Exhibition

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 10	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	10	10
Annual IC Time Burden (Hours)	500	500
Annual IC Cost Burden (Dollars)	15,000	15,000

Documents for IC

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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