Information Collection

International Terrorism Victim Expense Reimbursement Program

IC 192597 under ICR 202110-1121-001 · OMB 1121-0309.

Documents and Forms

Document Name Document Type
International Terrorism Victim Expense Reimbursement Program Form
ITVERP Application Supplemental Sheets OMB 1121-0309 2017.docx Other-supplemental sheets
ITVERP Claimant Satisfaction Tool 2017.docx Other-satisfaction form
ITVERP application ITVERP Application OMB 1121-0309 2017.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	International Terrorism Victim Expense Reimbursement Program	Agency IC Tracking Number:	OVC

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	none	ITVERP application	ITVERP Application OMB 1121-0309 2017.docx	none	Yes	No	Fillable Printable
Other-supplemental sheets			ITVERP Application Supplemental Sheets OMB 1121-0309 2017.docx	none	Yes	No	Fillable Printable
Other-satisfaction form			ITVERP Claimant Satisfaction Tool 2017.docx	none	Yes	No	Fillable Printable

Line of Business: International Affairs and Commerce

Subfunction: International Development and Humanitarian Aid

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 100	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	75	75
Annual IC Cost Burden (Dollars)	300	300

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.