Information Collection

Disclosure of Information related to Potential Violations

IC 182261 under ICR 201611-1405-005 · OMB 1405-0179.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1405-0179 can be found here:

Documents and Forms

Document Name Document Type
Form DS-7787 Disclosure of Information related to Potential Violations Form
(Final) 1405-0179 DS-7787 Disclosure Form Instructions.docx Instruction
DS-7787 Disclosure of Information Related to Potential Violation [FINAL] 1405-0179 DS-7787 Form v3.8.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Disclosure of Information related to Potential Violations	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 22 CFR 120-130 (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	DS-7787	Disclosure of Information Related to Potential Violations	[FINAL] 1405-0179 DS-7787 Form v3.8.pdf		Yes	Yes	Fillable Fileable
Instruction			(Final) 1405-0179 DS-7787 Disclosure Form Instructions.docx		Yes	Yes	Fillable Fileable

Line of Business: International Affairs and Commerce

Subfunction: Foreign Affairs

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,500	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,500	200	1,300
Annual IC Time Burden (Hours)	15,000	2,000	13,000
Annual IC Cost Burden (Dollars)	52,500	52,500	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.