View Information Collection (IC)
Skip to main content
An official website of the United States government
The .gov means it's official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.
The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.
Search:
Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
FSR 265 FTC Complaint Assistant, FSR 266 CFTC, FSR 267 HHS NIDCR, FSR 268 HHS NCI SEER, FSR 269 FDA
Agency IC Tracking Number:
FSR 265, FSR 266, FSR 267, FSR 268, FSR 269
IC Status:
Unchanged
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
FSR 265
FTC Complaint Assistant questionnaire
FSR 265 FTC ComplaintAssistant questionnaire.xls
Yes
Yes
Fillable Fileable
Form
FSR 266
CFTC questionnaire
FSR 266 CFTC questionnaire.xls
Yes
Yes
Fillable Fileable
Form
FSR 267
HHS NIDCR Spanish questionnaire
FSR 267 HHS NIDCR Spanish questionnaire.xls
Yes
Yes
Fillable Fileable
Form
FSR 268
HHS NCI SEER questionnaire
FSR 268 HHS NCI SEER questionnaire.xls
Yes
Yes
Fillable Fileable
Form
FSR 269
HHS FDA questionnaire
FSR 269 HHS FDA.xls
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
General Government
Subfunction:
Central Records & Statistical Mgt
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
25,000
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
100 %
Requested
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
25,000
0
0
0
0
25,000
Annual IC Time Burden (Hours)
1,042
0
0
0
0
1,042
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Justification for ICs to generic ICR 1090-0008
Justification for ICs to generic ICR 1090-0008.doc
07/29/2009
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.