Information Collection

Application and start up

IC 201794 under ICR 201204-1205-001 · OMB 1205-0492.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1205-0492 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Application Checklist.doc	Other-application checklist for demo
Draft demonstration agreement.rtf Agreement	IC Document

IC Title:

Application and start up

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

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
Other-application checklist for demonstration grants			Application Checklist.doc		Yes	Yes	Paper Only

Line of Business: Income Security

Subfunction: Unemployment Compensation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 10

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	Program Change Due to New Statute
Annual Number of Responses for this IC	10	10
Annual IC Time Burden (Hours)	2,400	2,400
Annual IC Cost Burden (Dollars)	98,340	98,340

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Agreement	Draft demonstration agreement.rtf	04/02/2012

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