Information Collection

Individual Eligibility Evaluation Form

IC 204092 under ICR 201204-3037-001 · OMB 3037-0012.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3037-0012 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 3037-0011 Individual Eligibility Eligibility Individual Eligibility Evaluation Form	Form
IEE INSTRUCTIONS.docx	Instruction
3037-0011 Individual Eligibility Eligibility IEE 83I.pdf	Form

IC Title:

Individual Eligibility Evaluation Form

Agency IC Tracking Number:

2012-3037-0011

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 41 CFR 51-4.3 (To search for a specific CFR, visit the Code of Federal Regulations.)

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
Instruction					No		Paper Only
Form	3037-0011				No		Paper Only

Line of Business: Economic Development

Subfunction: Business and Industry Development

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 602

Number of Respondents for Small Entity: 550

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	46,354	46,354
Annual IC Time Burden (Hours)	386	386
Annual IC Cost Burden (Dollars)	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.

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