View Information Collection Request (ICR) Package

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View ICR - OIRA Conclusion

OMB Control No: 1405-0218	ICR Reference No: 201710-1405-002
Status: Historical Active	Previous ICR Reference No: 201412-1405-002
Agency/Subagency: STATE/AFA	Agency Tracking No:
Title: Government, Corporate or Foundation, and Individual Donor Form Application
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/05/2017
	Date Received in OIRA: 10/18/2017
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2020	36 Months From Approved	12/31/2017
Responses	4,333	0	3,665
Time Burden (Hours)	361	0	305
Cost Burden (Dollars)	2,123	0	1,833

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	4,333	3,665	668
Annual Time Burden (Hours)	361	305	56
Annual Cost Burden (Dollars)	2,123	1,833	290

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: There was a slight increase in the burden hours associated with this collection, from 305 hours to 361, due to an increase of 56 donations since the last time this collection was approved

Annual Cost to Federal Government: $30,482

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination. No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination. Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

Agency Contact: Frances Gidez 202 647-6286 gidezfz@state.gov

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