Information Collection Request

Statement of Personal History

ICR 202602-3245-004 · OMB 3245-0080 · Received in OIRA

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form Form 1081 Statement of Personal History Form and Instruction Modified Available
OMB_A-129_Sept 2024.pdf Supplementary Document Uploaded 2026-02-25 Available
Regulatory Authority for Collection CFR 120.140-120.851 FINAL.docx Supplementary Document Uploaded 2026-02-24 Available
Supporting Statement Form 1081 FINAL 2-12-26 .docx Supporting Statement A Uploaded 2026-02-24 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
35635 Statement of Personal History Form and Instruction ModifiedStatement of Personal History
35635 Statement of Personal History Form and Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Requested Previously Approved
36 Months From Approved 04/30/2026
146 150
73 75
2,959 2,040





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1
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IC Title Form No. Form Name
Statement of Personal History Form 1081

table that charts list of burden
  Total Request Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 146 150 0 0 -4 0
Annual Time Burden (Hours) 73 75 0 0 -2 0
Annual Cost Burden (Dollars) 2,959 2,040 0 0 919 0


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