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Exit Form
Technology Clearinghouse National Online Electronic Assessment
OMB: 1640-0014
IC ID: 185981
OMB.report
DHS/S&T
OMB 1640-0014
ICR 200807-1640-001
IC 185981
( )
Documents and Forms
Document Name
Document Type
Form DHs Form 10054 (5/
Exit Form
Form and Instruction
DHs Form 10054 (5/ Exit Form
Exit Form.pdf
surveys.jsc.eku.edu/mrIWeb/mrIWeb.dll?I.Project=NOEAEXITFORM
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Exit Form
Agency IC Tracking Number:
DHS Form 10054 (5/08)
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 and Instruction
DHs Form 10054 (5/08)
Exit Form
Exit Form.pdf
http://surveys.jsc.eku.edu/mrIWeb/mrIWeb.dll?I.Project=NOEAEXITFORM
Yes
Yes
Fillable Fileable Signable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Homeland Security
Subfunction:
Key Asset and Critical Infrastructure Protection
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
100
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
100 %
Approved
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
100
0
100
0
0
0
Annual IC Time Burden (Hours)
20
0
20
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
No associated records found
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.