Information Collection

Withdrawal Questionnaire

IC 241548 under ICR 202003-0625-001 · OMB 0625-0276.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0625-0276 can be found here:

Documents and Forms

Document Name Document Type
EU-U.S. PS questionnaire_Withdrawal_01-13-2017.docx www.privacyshield.gov/welcome Other-Questionnaire

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Withdrawal Questionnaire	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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
Other-Questionnaire			EU-U.S. PS questionnaire_Withdrawal_01-13-2017.docx	https://www.privacyshield.gov/welcome	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: 86	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	86	86
Annual IC Time Burden (Hours)	29	29
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.