Information Collection

International Terrorism Victim Expense Reimbursement Program

IC 192597 under ICR 202606-1121-003 · OMB 1121-0309.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
ITVERP application International Terrorism Victim Expense Reimbursement Program	Form
ITVERP Application Supplemental Sheets OMB 1121-0309 2017.docx	Other-supplemental sheets
ITVERP Claimant Satisfaction Tool 2017.docx	Other-satisfaction form
ITVERP application ITVERP Application OMB 1121-0309 2017.docx	Form

IC Title:

Agency IC Tracking Number:

OVC

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.	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	none	Yes	No	Fillable Printable
Other-supplemental sheets		none	Yes	No	Fillable Printable
Other-satisfaction form		none	Yes	No	Fillable Printable

Line of Business: International Affairs and Commerce

Subfunction: International Development and Humanitarian Aid

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 100

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	75	75
Annual IC Cost Burden (Dollars)	300	300

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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