Exchange Form 3900-017 "Statement"

Exchange Accidents/Incidents Reports

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0702-0138 can be found here:

Documents and Forms

Document Name Document Type
Form Exchange Form 3900 Exchange Form 3900-017 "Statement" Form and Instruction
Exchange Form 3900 Statement EXCHANGE FORM 3900-017 STATEMENT.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Exchange Form 3900-017 "Statement"	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 and Instruction	Exchange Form 3900-017	Statement	EXCHANGE FORM 3900-017 STATEMENT.pdf		No		Paper Only

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4,854	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	4,854	4,854
Annual IC Time Burden (Hours)	4,854	4,854
Annual IC Cost Burden (Dollars)	35,192	35,192

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.