Information Collection

Application for the Community Development Block Grant Program for Indian Tribes and Alaska Native Villages (ICDBG)

IC 27850 under ICR 200809-2577-002 · OMB 2577-0191.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2577-0191 can be found here:

Documents and Forms

Document Name Document Type
Form HUD 4123 Application for the Community Development Block Grant Program for Indian Tribes and Alaska Native Villages (ICDBG) Form and Instruction
HUD 4123 Cost Summary 4123.pdf Form and Instruction
HUD 4125 Implementation Schedule 4125.pdf Form and Instruction
SF 424 Application for Federal Assistance sf424.pdf Form and Instruction
HUD 2880 Applicant/Receipt Disclosure/Update Report 2880.pdf Form and Instruction
HUD 2993 Acknowledgment of Application Receipt 2993.pdf Form and Instruction
SF 424 Supp Survey on Ensuring Equal Opportunity for Applicants sf424sup.pdf Form and Instruction
HUD 96010 Logic Model ICDBG ICDBG XL.xls Form and Instruction
SF 269 Financial Status Reports sf269.pdf Form and Instruction
SF 272 Federl Cash Transaction Report sf272.pdf Form and Instruction
HUD*2994-A Grant Applicant Survey 2994-A.doc Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Application for the Community Development Block Grant Program for Indian Tribes and Alaska Native Villages (ICDBG)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 24 CFR 1003

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	HUD 4123	Cost Summary	4123.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	HUD 4125	Implementation Schedule	4125.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	SF 424	Application for Federal Assistance	sf424.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	HUD 2880	Applicant/Receipt Disclosure/Update Report	2880.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	HUD 2993	Acknowledgment of Application Receipt	2993.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	SF 424 Supp	Survey on Ensuring Equal Opportunity for Applicants	sf424sup.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	HUD 96010	Logic Model ICDBG	ICDBG XL.xls	Yes	Yes	Fillable Fileable
Form and Instruction	SF 269	Financial Status Reports	sf269.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	SF 272	Federl Cash Transaction Report	sf272.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	HUD*2994-A	Grant Applicant Survey	2994-A.doc	Yes	Yes	Fillable Printable

Line of Business: Community and Social Services

Subfunction: Homeownership Promotion

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 225	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 99 %

	Requested	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,140	15	-100	1,225
Annual IC Time Burden (Hours)	9,370	45	0	9,325
Annual IC Cost Burden (Dollars)	0	0	0	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.