Information Collection

SF-269A Financial Status Report (Short Form)

IC 750 under ICR 200810-0348-003 · OMB 0348-0038.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SF-269A SF-269A Financial Status Report (Short Form)	Form and Instruction
SF-269A Financial Status Report (Short Form) sf269a.pdf www.whitehouse.gov/omb/grants/sf269a.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? Yes

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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 and Instruction	SF-269A	Financial Status Report (Short Form)	sf269a.pdf	http://www.whitehouse.gov/omb/grants/sf269a.pdf	Yes	Yes	Fillable Printable

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1

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	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	1	-100,000	100,000	1
Annual IC Time Burden (Hours)	1	0	0	1
Annual IC Cost Burden (Dollars)	0	0	0	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.