Information Collection

State, Local or Tribal Governments

IC 260015 under ICR 202602-3060-029 · OMB 3060-1309.

Documents and Forms

Document Name Document Type
Screenshot - PA Request Form 3.png Other-Privacy Act Request Form Scree
Screenshot - PA Request Form 4.png Other-Privacy Act Request Form Scree

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	State, Local or Tribal Governments	Agency IC Tracking Number:	OMD

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Privacy Act Request Form Screenshot			Screenshot - PA Request Form 3.png		Yes	Yes	Fillable Fileable Signable
Other-Privacy Act Request Form Screenshot			Screenshot - PA Request Form 4.png		Yes	Yes	Fillable Fileable Signable

Line of Business: General Government

Subfunction: Central Fiscal Operations

Privacy Act System of Records
Title: FCC/OMD-17, Freedom of Information Act (FOIA) and Privacy Act Requests	FR Citation: 88 FR 74179

Number of Respondents: 377	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 92 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	377	184	193
Annual IC Time Burden (Hours)	30	14	16
Annual IC Cost Burden (Dollars)	1,825	544	1,281

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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