Information Collection

Standard Assurances form

IC 12418 under ICR 200908-1121-001 · OMB 1121-0140.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1121-0140 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Standard Assurances form	Form and Instruction
Standard Assurances OJP_Standard_Assurances_(showing_3_4_2008_revision)_(2)[1].docx	Form and Instruction
OJP Standard Assurances (showing 3 4 2008 revision) (2).pdf Standard Assurances	IC Document
The change to standard assurances form.doc explanation for change	IC Document
gms login screen.pdf GMS login screen shots	IC Document

IC Title:

Standard Assurances form

Agency IC Tracking Number:

OGC/OCR

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

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	None	Standard Assurances	OJP_Standard_Assurances_(showing_3_4_2008_revision)_(2)[1].docx		Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Central Fiscal Operations

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,000

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 Potential Violation of the PRA
Annual Number of Responses for this IC	1,000	-5,371	6,371
Annual IC Time Burden (Hours)	10,000	7,440	2,560
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Standard Assurances	OJP Standard Assurances (showing 3 4 2008 revision) (2).pdf	06/12/2008
explanation for change	The change to standard assurances form.doc	06/12/2008
GMS login screen shots	gms login screen.pdf	11/23/2009

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.