Information Collection

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

IC 27850 under ICR 200901-2577-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Form HUD 4123 Cost Summary Application for the Community Development Block Grant Program for Indian Tribes and Alaska Native Villages (ICDBG)	Form and Instruction
Form HUD 4125 Implementation Schedule Application for the Community Development Block Grant Program for Indian Tribes and Alaska Native Villages (ICDBG)	Form and Instruction
Form SF 424 Application for Federal Assistance Application for the Community Development Block Grant Program for Indian Tribes and Alaska Native Villages (ICDBG)	Form and Instruction
Form HUD 2880 Applicant/Receipt Disclosure/Update Report Application for the Community Development Block Grant Program for Indian Tribes and Alaska Native Villages (ICDBG)	Form and Instruction
Form HUD 2993 Acknowledgment of Application Receipt Application for the Community Development Block Grant Program for Indian Tribes and Alaska Native Villages (ICDBG)	Form and Instruction
Form HUD 2994-A You are our Client! Application for the Community Development Block Grant Program for Indian Tribes and Alaska Native Villages (ICDBG)	Form and Instruction
Form SF 424 Supp Survey on Ensuring Equal Opportunity for Applicants Application for the Community Development Block Grant Program for Indian Tribes and Alaska Native Villages (ICDBG)	Form and Instruction
Form HUD 96010 Logic Model ICDBG Application for the Community Development Block Grant Program for Indian Tribes and Alaska Native Villages (ICDBG)	Form and Instruction
Form SF 269 Financial Status Reports Application for the Community Development Block Grant Program for Indian Tribes and Alaska Native Villages (ICDBG)	Form and Instruction
Form SF 272 Federl Cash Transaction Report 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
HUD 2994-A You are our Client! 2994.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

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:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	HUD 4123	Yes	Yes	Fillable Fileable
Form and Instruction	HUD 4125	Yes	Yes	Fillable Fileable
Form and Instruction	SF 424	Yes	Yes	Fillable Fileable
Form and Instruction	HUD 2880	Yes	Yes	Fillable Fileable
Form and Instruction	HUD 2993	Yes	Yes	Fillable Fileable
Form and Instruction	HUD 2994-A	Yes	Yes	Fillable Fileable
Form and Instruction	SF 424 Supp	Yes	Yes	Fillable Fileable
Form and Instruction	HUD 96010	Yes	Yes	Fillable Fileable
Form and Instruction	SF 269	Yes	Yes	Fillable Fileable
Form and Instruction	SF 272	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

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: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,140	-85	1,225
Annual IC Time Burden (Hours)	9,370	45	9,325
Annual IC Cost Burden (Dollars)	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.

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