Information Collection

State, Local or Tribal Governments

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

Documents and Forms

Documents and forms in this information collection
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

IC Title:

Agency IC Tracking Number:

OMD

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
Other-Privacy Act Request Form Screenshot					Yes	Yes	Fillable Fileable Signable
Other-Privacy Act Request Form Screenshot					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 %

table that charts list of burden
	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

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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