Information Collection

Information Request

IC 181788 under ICR 201007-1640-001 · OMB 1640-0011.

Documents and Forms

Document Name Document Type
Form DHS Form 10012 (04 Information Request Form and Instruction
DHS Form 10012 (04 Information Request DHS Form 10012 - Information Request.pdf www.techsolutions.dhs.gov Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Information Request	Agency IC Tracking Number:	10012

Is this a Common Form? No		IC Status: Modified

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 and Instruction	DHS Form 10012 (04/07)	Information Request	DHS Form 10012 - Information Request.pdf	https://www.techsolutions.dhs.gov	Yes	Yes	Fillable Fileable

Line of Business: Homeland Security

Subfunction: Catastrophic Defense

Privacy Act System of Records
Title: DHS/ALL-004	FR Citation: 74 FR 49882

Number of Respondents: 22	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	Previously Approved
Annual Number of Responses for this IC	22	-228	250
Annual IC Time Burden (Hours)	2	-19	21
Annual IC Cost Burden (Dollars)	0	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.