Information Collection

Application for the Community Development Block Grant Program for Indian Tribes and Alaska Native Villages (ICDBG)

IC 27850 under ICR 201105-2577-012 · OMB 2577-0191.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2577-0191 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form HUD 4123 Application for the Community Development Block Grant Program for Indian Tribes and Alaska Native Villages (ICDBG)	Form and Instruction
HUD-96010 2010 ICDBG Logic Model.xls	Other-Logic Model
HUD 4123 Cost Summary 4123.pdf	Form and Instruction
HUD 4125 Implementation Schedule 4125.pdf	Form and Instruction
SF 424 Application for Federal Assistance sf424.pdf	Form and Instruction
HUD 2880 Applicant/Receipt Disclosure/Update Report 2880.pdf	Form and Instruction
HUD 2993 Acknowledgment of Application Receipt 2993.pdf	Form and Instruction
HUD 2994-A You are our Client! 2994-A.doc	Form and Instruction
SF 424 Supp Survey on Ensuring Equal Opportunity for Applicants sf424sup.pdf	Form and Instruction
HUD 96010 Logic Model ICDBG ICDBG XL.xls	Form and Instruction
SF 269 Financial Status Reports sf269.pdf	Form and Instruction
SF 272 Federl Cash Transaction Report sf272.pdf	Form and Instruction
HUD 2516 Contract and Subcontract Activity 2516.pdf	Form and Instruction
SF 425 Federal Financial Request SF-425.pdf	Form and Instruction

IC Title:

Application for the Community Development Block Grant Program for Indian Tribes and Alaska Native Villages (ICDBG)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 24 CFR 1003

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	HUD 4123	Cost Summary	4123.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	HUD 4125	Implementation Schedule	4125.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	SF 424	Application for Federal Assistance	sf424.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	HUD 2880	Applicant/Receipt Disclosure/Update Report	2880.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	HUD 2993	Acknowledgment of Application Receipt	2993.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	HUD 2994-A	You are our Client!	2994-A.doc	Yes	Yes	Fillable Fileable
Form and Instruction	SF 424 Supp	Survey on Ensuring Equal Opportunity for Applicants	sf424sup.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	HUD 96010	Logic Model ICDBG	ICDBG XL.xls	Yes	Yes	Fillable Fileable
Form and Instruction	SF 269	Financial Status Reports	sf269.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	SF 272	Federl Cash Transaction Report	sf272.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	HUD 2516	Contract and Subcontract Activity	2516.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	SF 425	Federal Financial Request	SF-425.pdf	Yes	Yes	Fillable Fileable
Other-Logic Model			HUD-96010 2010 ICDBG Logic Model.xls	Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Homeownership Promotion

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 225

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	940	-200	1,140
Annual IC Time Burden (Hours)	10,095	725	9,370
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.