Information Collection

Application for Domestic Indemnification

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

Documents and Forms

Documents and forms in this information collection
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

IC Title:

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:

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	3135-0094				Yes	Yes	Fillable Fileable
Instruction					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 %

table that charts list of burden
	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

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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