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Federal forms, ICRs, and supporting documents

Information Collection

Eligibility Questionnaire For HAVANA Act Payments

IC 259681 under ICR 202605-1110-001CF · OMB 1405-0250.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form
Form and Instruction
Form
Information Collection (IC) Details

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Eligibility Questionnaire For HAVANA Act Payments
 
Modified
 
Required to Obtain or Retain Benefits
 
22 CFR 135

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction DS-4316 Eligibility Questionnaire for Havana Act Payments DS-4316 Updated.pdf eforms.state.gov Yes No Fillable Printable
Form DS-4316 Eligibility Questionnaire for HAVANA Act payments DS4316 - DRAFT - 12-22-2025.pdf https://eforms.state.gov Yes No Printable Only

Income Security General Retirement and Disability

FBI Central Records System  82 FR 24147

25 0
   
Federal Government
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 25 0 0 0 0 25
Annual IC Time Burden (Hours) 13 0 0 0 0 13
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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