Broadband-Match Web Site Tool

Documents and Forms

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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Broadband-Match Web Site Tool	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection 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 %

	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

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.