Information Collection

Supplemental Form to the Financial Status Report for all AoA Title III Grantees

IC 10243 under ICR 201408-0985-001 · OMB 0985-0004.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0985-0004 can be found here:

Documents and Forms

Document Name Document Type
Form No. 1 Supplemental Form to the Financial Status Report for all AoA Title III Grantees Form and Instruction
No. 1 Data collection form Supplemental Form and Instructions.docx Form and Instruction
269_Supplemental_Form_Instructions_to_OMB[1].doc Data collection form instructions IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Supplemental Form to the Financial Status Report for all AoA Title III Grantees	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	No. 1	Data collection form	Supplemental Form and Instructions.docx		Yes	Yes	Printable Only

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 56	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 95 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	112	112
Annual IC Time Burden (Hours)	224	224
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Data collection form instructions	269_Supplemental_Form_Instructions_to_OMB[1].doc	08/29/2007

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