Information Collection

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

IC 28982 under ICR 200702-3037-002 · OMB 3037-0002.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.