Information Collection

Supplemental Form to the Financial Status Report for all AoA Title III Grantees

IC 10243 under ICR 200708-0985-002 · OMB 0985-0004.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0985-0004 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form No. 1 Supplemental Form to the Financial Status Report for all AoA Title III Grantees	Form
No. 1 Data collection form 269_Supplemental_Form_to_OMB[1].doc	Form
269_Supplemental_Form_Instructions_to_OMB[1].doc Data collection form instructions	IC Document

IC Title:

Supplemental Form to the Financial Status Report for all AoA Title III Grantees

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

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	No. 1	Data collection form	269_Supplemental_Form_to_OMB[1].doc		Yes	Yes	Printable Only

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 56

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	112	112
Annual IC Time Burden (Hours)	112	112
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Data collection form instructions	269_Supplemental_Form_Instructions_to_OMB[1].doc	08/29/2007

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