Information Collection

Department of State Mentor-Protege Program Application

IC 38774 under ICR 200511-1405-003 · 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⚠️ Notice: This information collection may be referencing outdated material.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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	14	0	14
Annual IC Time Burden (Hours)	294	0	294
Annual IC Cost Burden (Dollars)	0	-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.