Information Collection

Brownfields Economic Development Initiative (BEDI) Grant Application

IC 27456 under ICR 201106-2506-001 · OMB 2506-0153.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form HUD-40123 Brownfields Economic Development Initiative (BEDI) Grant Application	Form and Instruction
HUD-40122 Sec. 10 Loan Guarantee Certification 40122.pdf	Form and Instruction
HUD-40123 Brownfields Economic Development Application 40123.pdf	Form and Instruction
SF-424 Applicaiton for Federal Assistance sf424.doc	Form and Instruction
SF-424S Survey on Ensuring Equal Opportunity for Applicants sf424sup.pdf	Form and Instruction
SF-LLL Disclosure of Lobbying Activities sflllin.pdf	Form and Instruction
HUD-424-B Applicant Assurance and Certification 424-b.pdf	Form and Instruction
HUD-2880 Applicant/Recipient Disclusre/Update Report 2880.doc	Form and Instruction
HUD-96010-I Logic Model 96010.pdf	Form and Instruction
HUD-2993 Acknowledgement of Application 2993.pdf	Form and Instruction
HUD-2990 Certificaiton of Consistency with the RC/EZ/EC Strategic 2990.pdf	Form and Instruction

IC Title:

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 570.208 24 CFR 570.703

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-40123	Brownfields Economic Development Application	40123.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	SF-424	Applicaiton for Federal Assistance	sf424.doc	Yes	Yes	Fillable Fileable
Form and Instruction	SF-424S	Survey on Ensuring Equal Opportunity for Applicants	sf424sup.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	SF-LLL	Disclosure of Lobbying Activities	sflllin.pdf	Yes	Yes	Fillable Printable
Form and Instruction	HUD-424-B	Applicant Assurance and Certification	424-b.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	HUD-2880	Applicant/Recipient Disclusre/Update Report	2880.doc	Yes	Yes	Fillable Fileable
Form and Instruction	HUD-96010-I	Logic Model	96010.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	HUD-2993	Acknowledgement of Application	2993.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	HUD-2990	Certificaiton of Consistency with the RC/EZ/EC Strategic Plan	2990.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	HUD-40122	Sec. 10 Loan Guarantee Certification	40122.pdf	Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 38

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
	Approved	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	38	-12	50
Annual IC Time Burden (Hours)	1,260	-740	2,000
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.