Information Collection

Broadband-Match Web Site Tool

IC 191487 under ICR 201010-0660-003 · OMB 0660-0033.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Broadband-Match Web Site Tool	Form and Instruction
Applicant Profile Form Broadband Match Tool.Applicant Profile Form.2010.pdf match.broadbandusa.gov/BTOPpartners/BPMprofileEntry.aspx	Form and Instruction
Sample Screen.Broadband-Match.NLDhomepage3A.JPG Sample Screen Shot	IC Document
Sample Screen.Broadband-Match.NLD.teacher3A (4).JPG Sample Screen Shot	IC Document
Sample Screen.Broadband-Match.NLD.volunteer3A (3).JPG Sample Screen Shot	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

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	Applicant Profile Form	Broadband Match Tool.Applicant Profile Form.2010.pdf	http://match.broadbandusa.gov/BTOPpartners/BPMprofileEntry.aspx	Yes	Yes	Fillable Fileable

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 4,500

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	4,500	4,500
Annual IC Time Burden (Hours)	1,125	1,125
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Sample Screen Shot	Sample Screen.Broadband-Match.NLDhomepage3A.JPG	12/03/2009
Sample Screen Shot	Sample Screen.Broadband-Match.NLD.teacher3A (4).JPG	12/03/2009
Sample Screen Shot	Sample Screen.Broadband-Match.NLD.volunteer3A (3).JPG	12/03/2009

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