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OMB Control No: 3090-0315	ICR Reference No: 202602-3090-001
Status: Received in OIRA	Previous ICR Reference No: 202011-3090-001
Agency/Subagency: GSA	Agency Tracking No:
Title: Ombudsman Inquiry/Request Instrument
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR: No
Type of Review Request: Regular	Date Submitted to OIRA: 02/27/2026

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	118	0
Time Burden (Hours)	30	0
Cost Burden (Dollars)	0	0

Annual Cost to Federal Government: $1,241

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. No

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? No

Agency Contact: Fredrick Landry 999 999-9999

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