U.S. Effects Screening Questionnaire

OMB 3420-0036

The form is used to conduct a preliminary screen of certain proposed investments or to request prior approval for certain investments made through OPIC-supported Financial Intermediaries that may have potential negative impacts on the U.S. economy or employment.

The latest form for U.S. Effects Screening Questionnaire expires 2021-01-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form OPIC-252 U.S. Effects Screening Questionnaire Form and Instruction
OPIC-252 Supporting Statement.pdf Supporting Statement A
U.S. Effects Screening Questionnaire Form and Instruction

All Historical Document Collections

201711-3420-003 Approved without change	Revision of a currently approved collection	2017-11-28
201411-3420-004 Approved with change	New collection (Request for a new OMB Control Number)	2014-11-13