Information Collection

Standard Assurance Form

IC 205263 under ICR 201603-1121-002 · OMB 1121-0140.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1121-0140 can be found here:

Documents and Forms

Document Name Document Type
Standard Assurance Form Form
Standard Assurance OJP_Standard_Assurances.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Standard Assurance Form	Agency IC Tracking Number:	OGC

Is this a Common Form? No		IC Status: Modified

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	none	Standard Assurance	OJP_Standard_Assurances.docx	n/a	Yes	No	Printable Only

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 8,250	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	8,250	8,250
Annual IC Time Burden (Hours)	2,750	2,750
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.