View Information Collection Request (ICR) Package

View ICR - Agency Submission

OMB Control No: 0690-0037	ICR Reference No: 202610-0690-001
Status: Received in OIRA	Previous ICR Reference No: 202309-0690-002
Agency/Subagency: DOC/OS	Agency Tracking No: Havana Act
Title: Eligibility Questionnaire for HAVANA Act Payments
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular	Date Submitted to OIRA: 10/30/2026

	Requested	Previously Approved
Expiration Date	36 Months From Approved	10/31/2026
Responses	40	20
Time Burden (Hours)	40	20
Cost Burden (Dollars)	0	0

ICR Summary of Burden

	Total Request	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	40	20	20
Annual Time Burden (Hours)	40	20	20
Annual Cost Burden (Dollars)	0	0	0

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: Respondent update due to renewal analysis from previous renewal submission

Annual Cost to Federal Government: $13,608

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. Yes

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? No

Agency Contact: Joyce Myers 202 909-7673

Something went wrong when downloading this file. If you have any questions, please send an email to risc@gsa.gov.