IMLS Grant Program Application and Post-Award Report Forms

Forms and Documents

Document Name	Status
Form Report Form 4 Final Report - Native American Grant Form and Instruction	New
Form Report Form 3a Discretionary Grant Final Performance Form and Instruction	New
Form Report Form 2 Discretionary Grant Interim Performance Report Form	New
Form Report Form 1 Discretionary Grant Performance Report Form	New
Form State Programs For Grants to States - SPR - Online Reporting System Form and Instruction	New
Form Application Form 8 National Medal for Museum/Library Services Nomination Form Form	New
Form Application Form 7 Grant Reviewer Application Form: Museum Professionals Form and Instruction	New
Form Application Form 6 Grant Reviewer Application Form: Library Professionals Form and Instruction	New
Form Application Form 4 Partnership Statement Form and Instruction	New
Form Application Form 5 Native American Grant - Budget - Basic A & Education B Form and Instruction	New
Form Application Form 3 Specifications for Projects that Develop Digital Products Form and Instruction	New
Form Application Form 1 Program Information Sheet Form and Instruction	New
Form Application Form 2 Budget Detailed Form - detailed + summary Form and Instruction	New
SF425_FFR_Instructions.pdf Supplementary Document	2012-09-19
SF-425.pdf Supplementary Document	2012-09-19
Burden estimates 2012_9-19-12_2.xlsx Supplementary Document	2012-09-19
Forms justification statement A 0071 revised 9-19-12.docx Supporting Statement A	2012-09-19
Abstract to be loaded thru Grants dot Gov - instructions.pdf Supplementary Document	2012-07-24
State Programs - Reporting Subawards Executive Comp.pdf Supplementary Document	2012-07-24
State Programs - Part B FY2010 allotment Pacific Grants.pdf Supplementary Document	2012-07-24
State Programs - Part A FY 2010 allotment Pacific Grants.pdf Supplementary Document	2012-07-24
State Programs - Non-Cons Assurances Form (SF-424B).pdf Supplementary Document	2012-07-24
State Programs - Legal Officers Certification form.pdf Supplementary Document	2012-07-24
State Programs - Internet Safety Certification form.pdf Supplementary Document	2012-07-24
State Programs - Information Update form.pdf Supplementary Document	2012-07-24
State Programs - Debarment Certification form.pdf Supplementary Document	2012-07-24
State Programs - AppAWorksheet FY2013 MOE Waiver Request.pdf Supplementary Document	2012-07-23
State Programs - 2013 Program Assurances - form.pdf Supplementary Document	2012-07-23
Schedule of Completion - instructions.pdf Supplementary Document	2012-07-23
Proof of NonProfit Status - instructions.pdf Supplementary Document	2012-07-23
Project Staff and Consultant Documents - instructions.pdf Supplementary Document	2012-07-23
Organizational Profile - instructions.pdf Supplementary Document	2012-07-23
SF3881 - ACH.pdf Supplementary Document	2012-09-19
sf270.pdf Supplementary Document	2012-09-19

IC Document Collections

IC ID	Document Title	Status
203441	Final Report - Native American Grant Form and Instruction	New
203440	Discretionary Grant Final Performance Form and Instruction	New
203439	Discretionary Grant Interim Performance Report Form	New
203438	Discretionary Grant Performance Report Form	New
203437	Grants to States - SPR - Online Reporting System Form and Instruction	New
203436	State Programs - Financial Status Report - Pacific Grants Instruction	New
203435	State Grants - Financial Status Report - States Instruction	New
203433	National Medal for Museum/Library Services Nomination Form Form	New
203432	Grant Reviewer Application Form: Museum Professionals Form and Instruction	New
203431	Grant Reviewer Application Form: Library Professionals Form and Instruction	New
203430	Partnership Statement Form and Instruction	New
203429	Native American Grant - Budget - Basic A & Education B Form and Instruction	New
203428	Specifications for Projects that Develop Digital Products Form and Instruction	New
203427	Program Information Sheet Form and Instruction	New
203426	Budget Detailed Form - detailed + summary Form and Instruction	New

ICR Details

OMB Control No: 3137-0071	ICR Reference No: 201207-3137-004
Status: Historical Active	Previous ICR Reference No: 201109-3137-003
Agency/Subagency: IMLS	Agency Tracking No:
Title: IMLS Grant Program Application and Post-Award Report Forms
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 09/20/2012
	Date Received in OIRA: 07/25/2012
Terms of Clearance: Updated supporting documents.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2015	36 Months From Approved	08/31/2013
Responses	10,015	0	5,207
Time Burden (Hours)	19,097	0	21,398
Cost Burden (Dollars)	523,442	0	700,746

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Abstract: IMLS requests clearance for the forms it uses for all of the grant program applications, post-award reporting, and peer reviewer applications. These forms are directly related to the generic clearance for IMLS grant application and award processes (3137-0029) for which a three-year extension is being submitted at this time.

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Authorizing Statute(s): None

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 91	05/10/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 135	07/13/2012
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 15

IC Title	Form No.	Form Name
Discretionary Grant Interim Performance Report	Report Form 2	Discretionary Grant Interim Performance Report
Grant Reviewer Application Form: Museum Professionals	Application Form 7	Grant Reviewer Application Form: Museum Professionals
National Medal for Museum/Library Services Nomination Form	Application Form 8b	National Award for Library and Museum Services Nomination Form
Discretionary Grant Final Performance	Report Form 3a, Report Form 3b	Final Performance Report: Part 1, Narrative ,   Final Performance Report: Part 2, Quantitative Information
Native American Grant - Budget - Basic A & Education B	Application Form 5a, Application Form 5b	Part A - Project Budget for Native American Basic Grant ,   Part B—Project Budget for Education/Assessment Op tion
Grants to States - SPR - Online Reporting System	State Programs Form 3	SPR Online reporting system for IMLS
Specifications for Projects that Develop Digital Products	Application Form 3	Specifications for Projects that Develop Digital Products
State Grants - Financial Status Report - States	State Grants Form 1	State Grants Financial Status Report - States
State Programs - Financial Status Report - Pacific Grants	State Programs Form 2	State Programs- Financial Status Report - Pacific Grants
Partnership Statement	Application Form 4	Partnership Statement
Discretionary Grant Performance Report	Report Form 1	Discretionary Grant Performance Report - Cover Sheet
Budget Detailed Form - detailed + summary	Application Form 2a, Application Form 2b	Budget: Detailed ,   Budget: Summary
Program Information Sheet	Application Form 1	Program Information Sheet
Grant Reviewer Application Form: Library Professionals	Application Form 6	Grant Reviewer Application Form: Library Reviewer
Final Report - Native American Grant	Report Form 4	Native American Library Services Basic Grant and Basic Grant with Education/Assessment Option Final Financial and Performance Report

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	10,015	5,207	0	4,808	0	0
Annual Time Burden (Hours)	19,097	21,398	0	-2,301	0	0
Annual Cost Burden (Dollars)	523,442	700,746	0	-177,304	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: recalculation of most recent applicants and forms

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 07/25/2012

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