PHS Supplements to Application for Federal Assistance (SF 424)

ICR 200505-0920-003

OMB: 0920-0428

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
0920-0428 200505-0920-003
Historical Active 200402-0920-013
HHS/CDC
PHS Supplements to Application for Federal Assistance (SF 424)
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 05/26/2005
Retrieve Notice of Action (NOA) 05/26/2005
  Inventory as of this Action Requested Previously Approved
02/28/2006 02/28/2006 02/28/2006
21,379 0 21,289
49,049 0 48,815
0 0 0

The documents within this clearance are used to elicit information primarily from governmental and other non-profit organizations, requesting financial assistance from PHS grant programs. In addition, several of these forms are used for third party notifications and to provide asssurances after an award is granted.

None
None


No

1
IC Title Form No. Form Name
PHS Supplements to Application for Federal Assistance (SF 424) SF-424, PHS-5161-1, CDC.124(E), CDC.0113, OPHS-1

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 21,379 21,289 0 90 0 0
Annual Time Burden (Hours) 49,049 48,815 0 234 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

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.
05/26/2005


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