Human Rights Violators List

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1405-0175 can be found here:

Documents and Forms

Document Name Document Type
Form DS-5090e Human Rights Violators List Form
DS-5090e Human Rights Abuse Report Form DS-5090e screenshots.doc rightsforms.state.gov/chrv/cuba.html Form
Legal Authorities-HRVL (Final).doc Legal Authorities IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Human Rights Violators List	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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	DS-5090e	Human Rights Abuse Report Form	DS-5090e screenshots.doc	http://rightsforms.state.gov/chrv/cuba.html	Yes	Yes	Fillable Fileable

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 7,300	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	7,300	7,300
Annual IC Time Burden (Hours)	1,825	1,825
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Legal Authorities	Legal Authorities-HRVL (Final).doc	08/15/2006

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.