SF-424 Individual

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 4040-0005 NEA SF-424 Individual Burden Estimate	Form	Removed	Available
Form 4040-0005 SF-424 Individual Burden Estimate	Form	Modified	Available
Form 4040-0005 NEH SF-424 Individual Burden Estimate	Form	Removed	Available
Form 4040-0005 USDA SF-424 Individual Burden Estimate	Form	Removed	Available
SF424-0005-SS-Common.docx	Supporting Statement A	Uploaded 2012-10-29	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
35967	NEA SF-424 Individual Burden Estimate	Form	Removed
186774	SF-424 Individual Burden Estimate	Form	Modified
186773	NEH SF-424 Individual Burden Estimate	Form	Removed
186772	USDA SF-424 Individual Burden Estimate	Form	Removed

ICR Details

OMB Control No: 4040-0005	ICR Reference No: 201210-4040-001
Status: Historical Active	Previous ICR Reference No: 200907-4040-002
Agency/Subagency: EGOV	Agency Tracking No: 17342
Title: SF-424 Individual
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  Yes
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 01/30/2013
	Date Received in OIRA: 10/29/2012
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2016	36 Months From Approved	01/31/2013
Responses	1	0	8,412
Time Burden (Hours)	1	0	3,824
Cost Burden (Dollars)	0	0	0

---

Abstract: The SF-424 Individualform supports the streamlined application requirements for individuals and reduces the administrative burden with a standard government-wide application form.

---

Authorizing Statute(s): US Code: 31 USC 6301-6308 Name of Law: null
  

Citations for New Statutory Requirements: None

---

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

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 39707	07/05/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 61405	10/09/2012
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
USDA SF-424 Individual Burden Estimate	4040-0005	SF-424 Individual
NEA SF-424 Individual Burden Estimate	4040-0005	SF-424 Individual
SF-424 Individual Burden Estimate	4040-0005	SF-424 Individual
NEH SF-424 Individual Burden Estimate	4040-0005	SF-424 Individual

---

ICR Summary of Burden

table that charts list 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	1	8,412	0	-8,411	0	0
Annual Time Burden (Hours)	1	3,824	0	-3,823	0	0
Annual Cost Burden (Dollars)	0	0	0	0	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: This request is to migrate the Individual form to a common form. The burden is thus reduced to only the burden estimated for HHS' use of the Individual form.

---

Annual Cost to Federal Government: $19

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? No

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

---

Common Form ICR:  Yes

OIRA authorizes any Agency to begin using a Common Form associated with this ICR automatically after 5 calendar days from the date the agency's RCF including the common form was received in OIRA.

Description/Changes for Common Form Usage:  This request is to migrate the Individual form to a common form.

Approved RCFs using this ICR

table that charts list of RCF

Agency/Sub Agency	RCF ID	RCF Title	RCF Status	IC Title
USDA/RHS	201305-0575-001CF	7 CFR 1942-A, Community Facilities Loans	Historical Active	SF-424 Individual Burden Estimate
USDA/NIFA	201404-0524-052CF	SF 424 Discretionary	Historical Active	SF-424 Individual Burden Estimate
USDA/RBS	201303-0570-003CF	Small Socially-Disadvantaged Producer Grant Programs	Historical Active	SF-424 Individual Burden Estimate
NEH	201304-3136-001CF	SF 424Individual 4040-0005	Historical Active	SF-424 Individual Burden Estimate
USDA/RBS	201302-0570-001CF	Rural Microentrepreneur Assistance Program	Historical Active	SF-424 Individual Burden Estimate
NEA	201307-3135-002CF	Request to use Standard Form 424-Individual	Historical Active	SF-424 Individual Burden Estimate
DOT/FTA	201305-2132-013CF	Application for Federal Assistance SF-424	Historical Active	SF-424 Individual Burden Estimate
DOT/FTA	201304-2132-011CF	Application for Federal Assistance SF-424	Historical Active	SF-424 Individual Burden Estimate
DOT/FTA	201304-2132-010CF	Application for Federal Assistance SF-424	Historical Active	SF-424 Individual Burden Estimate
DOT/FTA	201304-2132-009CF	Application for Federal Assistance SF-424	Historical Active	SF-424 Individual Burden Estimate
DOI/ONRR	201604-1012-002CF	Request to use SF-424 Individual common form for ONRR	Historical Active	SF-424 Individual Burden Estimate
USDA/RUS	201610-0572-009CF	SF-424 Application for Federal Assistance - Individual	Historical Active	SF-424 Individual Burden Estimate
TREAS/CDFIF	201609-1559-001CF	CDFI SF-424 Individual Form Use	Historical Active	SF-424 Individual Burden Estimate

---

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: 10/29/2012

---