Information Collection

Refund Request

IC 187210 under ICR 201109-0651-002 · OMB 0651-0043.

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Information Collection (IC) Details

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IC Title:	Refund Request	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 37 CFR 1.26, 1.28 37 CFR 2.209

Information Collection Instruments:

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

Line of Business: Economic Development

Subfunction: Intellectual Property Protection

Privacy Act System of Records
Title: Deposit Accounts and Electronic Funds Transfer Profiles	FR Citation: 71 FR 38387

Number of Respondents: 8,660	Number of Respondents for Small Entity: 1,732

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

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	8,660	186	8,474
Annual IC Time Burden (Hours)	606	13	593
Annual IC Cost Burden (Dollars)	3,810	251	3,559

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