Information Collection

Certification Regarding Adjustment For Damage Or Neglect Pursuant To 203.379(c)

IC 144493 under ICR 198708-2502-005 · OMB 2502-0349.

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Information Collection (IC) Details

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IC Title:	CERTIFICATION REGARDING ADJUSTMENT FOR DAMAGE OR NEGLECT PURSUANT TO 203.379(C)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 280	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	620	620
Annual IC Time Burden (Hours)	310	310
Annual IC Cost Burden (Dollars)	0	0

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