Information Collection

Partnership Statement

IC 203430 under ICR 201207-3137-004 · OMB 3137-0071.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3137-0071 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Application Form 4 Partnership Statement	Form and Instruction
Application Form 4 Partnership Statement Partnership Statement.pdf www.imls.gov/assets/1/AssetManager/Partner.pdf	Form and Instruction
Partnerships and the Partnership Statement - instructions.pdf Partnerships and Partnership Statement - instructions	IC Document

IC Title:

Partnership Statement

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

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
Form and Instruction	Application Form 4	Partnership Statement	Partnership Statement.pdf	http://www.imls.gov/assets/1/AssetManager/Partner.pdf	Yes	Yes	Fillable Fileable

Line of Business: Education

Subfunction: Cultural and Historic Preservation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,111

Number of Respondents for Small Entity: 250

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 99 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,111	1,111
Annual IC Time Burden (Hours)	189	189
Annual IC Cost Burden (Dollars)	5,177	5,177

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Partnerships and Partnership Statement - instructions	Partnerships and the Partnership Statement - instructions.pdf	07/23/2012

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