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

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Form 404 Annual Certification - Qualified Nonprofit Agency Serving People Who Are Severely Disabled Form
404-Instructions.docx Instruction
404 Annual Certification - Qualified Nonprofit Agencies Serv 404 Form.doc Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Annual Certification - Qualified Nonprofit Agency Serving People Who Are Severely Disabled	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	404	Annual Certification - Qualified Nonprofit Agencies Serving People Who Are Severely Disabled	404 Form.doc		Yes	No	Paper Only
Instruction			404-Instructions.docx		Yes	No	Paper Only

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 555	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	555	-10	565
Annual IC Time Burden (Hours)	3,330	1,635	1,695
Annual IC Cost Burden (Dollars)	99,900	99,900	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.