Information Collection

Application for a Short-Term Grant (43 CFR 2804.12(a) and 2809.19(d))

IC 211334 under ICR 201603-1004-001 · OMB 1004-0206.

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Documents and Forms

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Information Collection (IC) Details

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IC Title:	Application for a Short-Term Grant (43 CFR 2804.12(a) and 2809.19(d))	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 43 CFR 2809.19(d) 43 CFR 2804.12(a)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Energy

Subfunction: Energy Resource Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1	Number of Respondents for Small Entity: 1

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1	1
Annual IC Time Burden (Hours)	8	8
Annual IC Cost Burden (Dollars)	1,156	1,156

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