Information Collection

Supplement Experience Statement

IC 176592 under ICR 197810-3206-004 · OMB 3206-0038.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3206-0038 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	SUPPLEMENT EXPERIENCE STATEMENT	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

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
Form	CSC 1170				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 844,720	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	844,720	18,367	826,353
Annual IC Time Burden (Hours)	472,892	11,846	461,046
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.