Information Collection

CIS OMBudsman Case Assistance Form

IC 44790 under ICR 202109-1601-002 · OMB 1601-0004.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1601-0004 can be found here:

Documents and Forms

Document Name Document Type
Form DHS-7001 CIS Ombudsman Case Assistance Form Form and Instruction
Form DHS-7001 Case Assistance Form CIS Ombudsman Case Assistance Form Form and Instruction
DHS-7001 Case Assistance Form cisomb_dhsform7001_instructions_AUG_2014_V24.pdf Form and Instruction
DHS-7001 Case Assistance Form DHS Request for Case Assistance Form 7001.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	CIS Ombudsman Case Assistance Form	Agency IC Tracking Number:

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-7001	Case Assistance Form	DHS Request for Case Assistance Form 7001.pdf		No		Fillable Fileable

Line of Business: Homeland Security

Subfunction: Border and Transportation Security

Privacy Act System of Records
Title: DHS/CISOMB-001 Case Assistance Analytics and Data Integration System of Records Notice	FR Citation: 86 FR 59408

Number of Respondents: 18,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	18,000	6,000	12,000
Annual IC Time Burden (Hours)	18,000	6,000	12,000
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.

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