Information Collection

Department of State Mentor-Protege Program Application

IC 15052 under ICR 200501-1405-001 · OMB 1405-0161.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1405-0161 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	Department of State Mentor-Protege Program Application	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
Form	DS-4053				Yes	Yes

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 14	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 50 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	14	14
Annual IC Time Burden (Hours)	294	294
Annual IC Cost Burden (Dollars)	11,000	11,000

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.