Annual Certification - Qualified Nonprofit Agency Serving People Who Are Severely Disabled

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3037-0002 can be found here:

Documents and Forms

Document Name Document Type
Form Committee Form 404 Annual Certification - Qualified Nonprofit Agency Serving People Who Are Severely Disabled Form
Committee Form 404 Annual Certification - Qualified Nonprofit Agency Servin Accountability DRAFT 404 Form.doc www.jwod.gov Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Annual Certification - Qualified Nonprofit Agency Serving People Who Are Severely Disabled	Agency IC Tracking Number:	404-02-27-2007

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 41 CFR 51-4.3 (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	Committee Form 404	Annual Certification - Qualified Nonprofit Agency Serving People Who Are Severely Disabled	Accountability DRAFT 404 Form.doc	www.jwod.gov	Yes	No	Printable Only

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 565	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	565	0	565
Annual IC Time Burden (Hours)	12,430	10,735	1,695
Annual IC Cost Burden (Dollars)	621,500	621,500	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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