Information Collection

Net Worth Certificate Act Application For Capital Assistance

IC 152603 under ICR 198303-3068-003 · OMB 3068-0500.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3068-0500 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	NET WORTH CERTIFICATE ACT APPLICATION FOR CAPITAL ASSISTANCE	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?
Form	1286	No	No
Form	1286A	No	No
Form	1287	No	No
Form	1287A	No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 862	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,724	862	862
Annual IC Time Burden (Hours)	5,172	2,586	2,586
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.