Document
Agency Information Collection Activities; Submission for OMB Review; Comment Request; Request for Individual Access to Records Protected Under the Privacy Act and Consent for Disclosure of Records Protected Under the Privacy Act
The Department of the Treasury will submit the following information collection requests to the Office of Management and Budget (OMB) for review and clearance in accordance with...
SUPPLEMENTARY INFORMATION:
Title:
Request for Individual Access to Records Protected under the Privacy Act and Consent for Disclosure of Records Protected under the Privacy Act.
OMB Control Number:
1505-NEW.
Type of Review:
Extension without change of a currently approved collection.
Description:
The
Request for Individual Access to Records Protected under the Privacy Act and Consent for Disclosure of Records Protected under the Privacy Act,
was developed in accordance with the Office of Management and Budget (OMB) Memorandum
M-21-04, Modernizing Access to and Consent for Disclosure of Records Subject to the Privacy Act,
which implements the requirements of the Creating Advanced Streamlined Electronic Services for Constituents Act of 2019 (“
CASES Act
”). This form is based on the mandatory OMB M-21-04 templates for individuals to submit requests for accessing and consenting to the disclosure of records protected under the Privacy Act of 1974, as amended, 5 U.S.C. 552a.
The
Request for Individual Access to Records Protected under the Privacy Act
form is used by individuals seeking access to their records under the Privacy Act and any information pertaining to them that are maintained in Treasury's systems of records. The Privacy Act provides that “the parent of any minor, or the legal guardian of any individual who has been declared to be incompetent due to physical or mental incapacity or age by a court of competent jurisdiction, may act on behalf of the individual.” Therefore, this form may also be used by a parent or legal guardian.
Form Number:
None.
Affected Public:
Public Individuals.
Estimated Number of Respondents:
316.
Frequency of Response:
Annual.
Estimated Total Number of Annual Responses:
316.
Estimated Time per Response:
3 hours.
Estimated Total Annual Burden Hours:
948.
Authority: 44 U.S.C. 3501 et seq.
Melody Braswell,
Treasury PRA Clearance Officer.