Individuals and Households

Donor Certification Form

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1090-0009 can be found here:

Documents and Forms

Document Name Document Type
Individuals and Households Form
Donor Certification Form DOI Donor Certification Form FINAL 4.17.09.doc www.doi.gov/pmb Form

Information Collection (IC) Details

IC Title:	Individuals and Households	Agency IC Tracking Number:	1

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	None	Donor Certification Form	DOI Donor Certification Form FINAL 4.17.09.doc	http://www.doi.gov/pmb	Yes	Yes	Fillable Printable

Line of Business: General Government

Subfunction: Central Property Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 150	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 33 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	150	150
Annual IC Time Burden (Hours)	50	50
Annual IC Cost Burden (Dollars)	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.