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

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

OMB: 3037-0002

IC ID: 28982

Information Collection (IC) Details

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Annual Certification - Qualified Nonprofit Agency Serving People Who Are Severely Disabled
 
No Modified
 
Required to Obtain or Retain Benefits
 

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

Community and Social Services Social Services

 

555 0
   
Private Sector Not-for-profit institutions
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 555 0 -10 0 0 565
Annual IC Time Burden (Hours) 3,330 0 1,635 0 0 1,695
Annual IC Cost Burden (Dollars) 99,900 0 99,900 0 0 0

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