Burden Statement

burden statement_Promise Zone certification form.doc

Promise Zones

Burden Statement

OMB: 2506-0209

Document [doc]
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Surveys, forms, electronic submission etc, must inform the respondents of the information (blue text) below. Two samples are also included.


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

(i) Why the information is being collected;

(ii) Use of the 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;



"Public reporting burden for this collection of information is estimated to average one hour. This includes the time for collecting, reviewing, and reporting the data. The information is being collected for the Promise Zone Initiative and will be used for certifying that the a grant applicant is eligible to access preference points or priority/special consideration for selected federal grant programs, technical assistance and other capacity building opportunities that will strengthen revitalization efforts in a Promise Zone community.


Response to this request for information is required in order to receive the benefits to be derived. This agency may not collect this information, and you are not required to complete this form unless it displays a currently valid OMB control number. No confidentiality is assured.”




The information collection requirements contained in this document have been approved by the Office of Management and Budget (OMB) under the Paperwork Reduction Act of 1995 (44 U.S.C. 3501-3520) and assigned OMB control number 2527-0279. There is no personal information contained in this application. Information on activities and expenditures of grant funds is public information and is generally available for disclosure. Recipients are responsible for ensuring confidentiality when disclosure is not required. In accordance with the Paperwork Reduction Act, HUD may not conduct or sponsor, and a person is not required to respond to, a collection of information unless the collection displays a currently valid OMB control number.

File Typeapplication/msword
File TitlePublic reporting burden for the collection of information is estimated to average 30 minutes
AuthorWayne W. Eddins
Last Modified ByHUD User
File Modified2014-09-09
File Created2014-09-09

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