Sequestered Juror Information Form

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1105-0096 can be found here:

Documents and Forms

Document Name Document Type
Form USM-523A Sequestered Juror Information Form Form and Instruction
USM-523A Sequestered Juror Information Form usm523a-revised.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Sequestered Juror Information Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	USM-523A	Sequestered Juror Information Form	usm523a-revised.pdf		No		Fillable Fileable

Line of Business: Litigation and Judicial Activities

Subfunction: Legal Prosecution and Litigation

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 14	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	14	14
Annual IC Time Burden (Hours)	1	1
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.