The form must
display the current OMB approval number of 3001-0091. All
references to other OMB approval numbers must be deleted from the
form. This approval is for the modified version of the form. The
modified version deletes item 3 from part II, replaces Section F of
part III and the instructions for Section F part III, deletes the
two pages of BHN definitions and the reference to the BHN
definitions, and deletes entirely the "Administrative Milestones"
page of part IV.
Inventory as of this Action
Requested
Previously Approved
11/30/1986
11/30/1986
11/30/1983
558
0
2,780
26,554
0
39,615
0
0
0
RESPONDENTS ARE PUBLIC AGENCIES AND
PRIVATE NONPROFITS. NEED IS TO FULFILL THE APPLICATION REQUIREMENTS
SPECIFIED BY OMB CIRCULARS A-102 AND A-110. USED TO MAKE DECISIONS
REGARDING FUNDING.
On behalf of this Federal agency, I certify that
the collection of information encompassed by this request complies
with 5 CFR 1320.9 and the related provisions of 5 CFR
1320.8(b)(3).
The following is a summary of the topics, regarding
the proposed collection of information, that the certification
covers:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a
benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control
number;
If you are unable to certify compliance with any of
these provisions, identify the item by leaving the box unchecked
and explain the reason in the Supporting Statement.