| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | ||||||||||||
| Community Outreach and Assistance Partnership Program | 0563-0066 | |||||||||||||
| DATE PREPARED | ||||||||||||||
| December 5, 2011 | ||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | |||||||||||||
| REPORTS | RECORDS | |||||||||||||
| TOTAL | ||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | ||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | ||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | ||||||
| RESPONDENT | KEEPER | |||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | ||||
| Narrative Title Page | None | 120 | 1.00 | 120.00 | 0.3300 | 39.60 | 0.00 | |||||||
| Narrative | None | 120 | 1.00 | 120.00 | 2.1600 | 259.20 | 0.00 | |||||||
| Delivery Plan | None | 120 | 1.00 | 120.00 | 2.1600 | 259.20 | 0.00 | |||||||
| Statement of Work | None | 120 | 1.00 | 120.00 | 4.0000 | 480.00 | 0.00 | |||||||
| Budget Narrative | None | 120 | 1.00 | 120.00 | 1.0000 | 120.00 | 0.00 | |||||||
| Certification Regarding Debarment, Suspension, and other Responsibility Matters - Primary Covered Transactions | AD-1047 | 120 | 1.00 | 120.00 | 0.1600 | 19.20 | ||||||||
| Certification Regarding Drug-Free Workplace Requirements (Grants) | AD-1049 | 120 | 1.00 | 120.00 | 0.1600 | 19.20 | ||||||||
| Disclosure of Lobbying Activities (form approved under 0348-0046) | SF-LLL | 120 | 1.00 | 120.00 | 0.1600 | 19.20 | ||||||||
| SUBTOTAL | 960.00 | 1,215.60 | 0.00 | 0.00 | ||||||||||
| TOTAL OF ALL PAGES | 960.00 | 1,215.60 | 0.00 | 0.00 | ||||||||||
| TOTAL - COLUMNS "F" AND "I" = OMB 831, 13 b; COLUMNS "H" AND "K" = OMB 831, 13c | 960.00 | 1,215.60 | ||||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | ||||||||||||
| Community Outreach and Assistance Partnership Program | 0563-0066 | |||||||||||||
| DATE PREPARED | ||||||||||||||
| December 5, 2011 | ||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | |||||||||||||
| REPORTS | RECORDS | |||||||||||||
| TOTAL | ||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | ||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | ||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | ||||||
| RESPONDENT | KEEPER | |||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | ||||
| Forms & burden approved under other OMB numbers | 0.00 | 0.00 | 0.00 | |||||||||||
| Application for Federal Assistance (4040-0004) | SF 424 | 120 | 1.0000 | 120.00 | 1.5000 | 180.00 | 0.00 | |||||||
| Budget Information Non-Construction Programs (4040-0006) | SF 424A | 120 | 1.0000 | 120.00 | 6.0000 | 720.00 | 0.00 | |||||||
| Assurances Non-Construction Programs (4040-0007) | SF 424B | 120 | 1.0000 | 120.00 | 0.2500 | 30.00 | 0.00 | |||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| SUBTOTAL | 360.00 | 930.00 | 0 | 0.00 | ||||||||||
| File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |