Information Collection

Authorization Letter for Data Provider

IC 183227 under ICR 200801-1640-001 · OMB 1640-0012.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1640-0012 can be found here:

Documents and Forms

Document Name Document Type
Form 10039 (12/07) Authorization Letter for Data Provider Form and Instruction
10039 (12/07) Authorization Letter Data Provider PREDICT_AuthorizationLtr_DP.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Authorization Letter for Data Provider	Agency IC Tracking Number:	10039

Is this a Common Form? No		IC Status: New

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 and Instruction	10039 (12/07)	Authorization Letter Data Provider	PREDICT_AuthorizationLtr_DP.pdf		Yes	No	Printable Only

Line of Business: Homeland Security

Subfunction: Key Asset and Critical Infrastructure Protection

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 10	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	10	10
Annual IC Time Burden (Hours)	10	10
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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