Department of State Mentor-Protege Program Application

ICR 200511-1405-003

OMB: 1405-0161

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
38774 Migrated
ICR Details
1405-0161 200511-1405-003
Historical Active 200501-1405-001
STATE/AFA
Department of State Mentor-Protege Program Application
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 11/23/2005
Retrieve Notice of Action (NOA) 11/23/2005
  Inventory as of this Action Requested Previously Approved
04/30/2008 04/30/2008 04/30/2008
14 0 14
294 0 294
0 0 11,000

The U.S. Department of State is implementing a Mentor-Protege Program that encourages agreements between large (and small) business prime contractor mentors and eligible small business proteges. To execute the program, business related data must be collected and evaluated from each memtor-protege team.

None
None


No

1
IC Title Form No. Form Name
Department of State Mentor-Protege Program Application DS-4053

  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 14 14 0 0 0 0
Annual Time Burden (Hours) 294 294 0 0 0 0
Annual Cost Burden (Dollars) 0 11,000 0 0 -11,000 0
No
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.
11/23/2005


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