Information Collection

Promissory Note and Loan Agreement

IC 199910 under ICR 201409-3133-001 · OMB 3133-0138.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3133-0138 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
2014 Loan Agreement Letterhead v3.docx	Other-Agreement
2014 Promissory Note Letterhead v2.docx	Other-Promissory Note

IC Title:

Promissory Note and Loan Agreement

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 12 CFR 705.6(2)(g)

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
Other-Agreement				www.cybergrants.com	Yes	Yes	Fillable Printable
Other-Promissory Note				www.cybergrants.com	Yes	Yes	Fillable Printable

Line of Business: Economic Development

Subfunction: Business and Industry Development

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 15

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 99 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	15	10	5
Annual IC Time Burden (Hours)	45	25	20
Annual IC Cost Burden (Dollars)	1,350	1,350	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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