Information Collection

Incident Reporting Form

IC 228877 under ICR 202307-1670-004 · OMB 1670-0037.

Documents and Forms

Document Name Document Type
Incident Reporting Form Form and Instruction
Incident Reporting Form (v1_0) (2024) revised 09.24.2024.pdf Form and Instruction
Incident Reporting Form - Visual Mockup.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Incident Reporting 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	N/A	N/A	Incident Reporting Form (v1_0) (2024) revised 09.24.2024.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	N/A	N/A	Incident Reporting Form - Visual Mockup.pdf		Yes	Yes	Fillable Fileable

Line of Business: Homeland Security

Subfunction: Key Asset and Critical Infrastructure Protection

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 26,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	26,000	0	26,000
Annual IC Time Burden (Hours)	8,667	0	8,667
Annual IC Cost Burden (Dollars)	366,607	366,607	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.