IMLS Grant Program Application and Post-Award Report Forms

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form IMLS-CLR-F-0026A IMLS Interim Performance Report Cover Sheet	Form	Unchanged	Available
Form IMLS-CLR-F-0022A IMLS Final Performance Report Cover Sheet	Form	Unchanged	Available
Form State Financial St State Financial Status Report Final	Form	Unchanged	Available
Form FY17 National Meda FY17 National Medal cover sheet form	Form and Instruction	Unchanged	Available
Form FY16 Interim Perfo FY16 Interim Performance Report form	Form	Unchanged	Available
Form FY16 Final Perform FY16 Final Performance Report	Form	Unchanged	Available
Form FY16 Museum Review FY16 Museum Reviewer	Form and Instruction	Unchanged	Available
Form FY16 Library Revie FY16 Library Reviewer form	Form and Instruction	Unchanged	Available
Form FY16 NA Basic Fina FY16 NA Basic Final Financial & Performance Reporting	Form and Instruction	Unchanged	Available
Form FY 16 Native Ameri FY 16 Native American Education Budget B	Form and Instruction	Unchanged	Available
Form FY16 NA Basic Budg FY16 Native American Basic Budget A	Form and Instruction	Unchanged	Available
Form Digital Stewardshi Digital Stewardship Supplementary Information Form	Form and Instruction	Removed	Available
Form Budget Form 1 IMLS Budget Form	Form	Removed	Available
Justification for Change - Budget PIS Digital - for removal to OMB.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2016-06-06	Available
Justification for Change - 3137-0071 NMMLS 2017.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2016-04-29	Available
Performance Report justification for changes 10-15-15.pdf	Justification for No Material/Nonsubstantive Change	Uploaded 2015-10-16	Repair queued
PRA burden estimates revised for performance report 20151015.xlsx	Supplementary Document	Uploaded 2015-10-15	Available
Justification for Change 3137-0071 General Clearance Grant Application and Post-Award Processes.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2015-09-02	Available
Forms justification statement A 0071_2015.docx	Supporting Statement A	Uploaded 2015-09-02	Available
Burden estimate for IMLS.xlsx	Supplementary Document	Uploaded 2015-06-01	Repair queued
PRA burden est 20150528.xlsx	Supplementary Document	Uploaded 2015-06-01	Available
SF-3881.pdf	Supplementary Document	Uploaded 2015-06-01	Available
SF-425.pdf	Supplementary Document	Uploaded 2015-06-01	Repair queued
SF-425 Instructions.pdf	Supplementary Document	Uploaded 2015-06-01	Available
SF-424S.pdf	Supplementary Document	Uploaded 2015-06-01	Available
SF-424S Instructions_IMLS.pdf	Supplementary Document	Uploaded 2015-06-01	Available
SF-270.pdf	Supplementary Document	Uploaded 2015-06-01	Available
State Programs - Program Assurances and Certifications.pdf	Supplementary Document	Uploaded 2015-06-01	Repair queued
State Programs - Legal Certification form.pdf	Supplementary Document	Uploaded 2015-06-01	Available
State Programs - Internet Safety Certification form.pdf	Supplementary Document	Uploaded 2015-06-01	Available
State Programs - Information Update form.pdf	Supplementary Document	Uploaded 2015-06-01	Available
State Programs - Certification LSTA State Program Report.pdf	Supplementary Document	Uploaded 2015-06-01	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
218577	IMLS Interim Performance Report Cover Sheet	Form	Unchanged	IMLS Interim Performance Report Cover Sheet
218576	Final Performance Report Cover sheet	Form	Unchanged	IMLS Final Performance Report Cover Sheet
216833	Grants to States Reporing Requirements and status reports	Form	Unchanged	State Financial Status Report Final
216833	Grants to States Reporing Requirements and status reports	Instruction	Unchanged
216832	FY16 National Medal for Museum and Library Service cover sheet	Form and Instruction	Unchanged	FY17 National Medal cover sheet form
216831	FY16 IMLS Interim Performance Report	Form	Unchanged	FY16 Interim Performance Report form
216830	FY16 IMLS Final Performance Report	Form	Unchanged	FY16 Final Performance Report
216828	Museum Reviewer form	Form and Instruction	Unchanged	FY16 Museum Reviewer
216827	Library Reviewer form	Form and Instruction	Unchanged	FY16 Library Reviewer form
216825	FY16 Native American Basic Final Financial and Performance Report	Form and Instruction	Unchanged	FY16 NA Basic Final Financial & Performance Reporting
216823	FY16 Native American Basic Budget A & B	Form and Instruction	Unchanged	FY 16 Native American Education Budget B
216823	FY16 Native American Basic Budget A & B	Form and Instruction	Unchanged	FY16 Native American Basic Budget A
216822	Program Information Form	Instruction	Removed
216821	Digital Stewardship	Form and Instruction	Removed	Digital Stewardship Supplementary Information Form
216820	Budget Form	Form	Removed	IMLS Budget Form

ICR Details

OMB Control No: 3137-0071	ICR Reference No: 201606-3137-005
Status: Historical Active	Previous ICR Reference No: 201604-3137-003
Agency/Subagency: IMLS	Agency Tracking No:
Title: IMLS Grant Program Application and Post-Award Report Forms
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 06/07/2016
Retrieve Notice of Action (NOA)	Date Received in OIRA: 06/06/2016
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2018	07/31/2018	07/31/2018
Responses	7,367	0	7,367
Time Burden (Hours)	15,085	0	15,085
Cost Burden (Dollars)	417,391	0	417,391

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Abstract: IMLS requests clearance for the forms it uses for all of the grant program applications, post-award reporting, and peer reviewer applications. These forms are directly related to the generic clearance for IMLS grant application and award processes (3137-0029) for which a three-year extension is being submitted at this time.

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Authorizing Statute(s): None

Citations for New Statutory Requirements: None

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 25	02/06/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 90	05/22/2015
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 10

table that charts list of burden

IC Title	Form No.	Form Name
Budget Form	Budget Form 1	IMLS Budget Form
Digital Stewardship	Digital Stewardship form 1	Digital Stewardship Supplementary Information Form
FY16 IMLS Final Performance Report	FY16 Final Performance Report form 1	FY16 Final Performance Report
FY16 IMLS Interim Performance Report	FY16 Interim Performance Report form 1	FY16 Interim Performance Report form
FY16 National Medal for Museum and Library Service cover sheet	FY17 National Medal cover sheet form 1	FY17 National Medal cover sheet form
FY16 Native American Basic Budget A & B	FY16 NA Basic Budget A 1, FY 16 Native American Education Budget B form 2	FY16 Native American Basic Budget A ,   FY 16 Native American Education Budget B
FY16 Native American Basic Final Financial and Performance Report	FY16 NA Basic Final Financial & Perf Reporting	FY16 NA Basic Final Financial & Performance Reporting
Final Performance Report Cover sheet	IMLS-CLR-F-0022A	IMLS Final Performance Report Cover Sheet
Grants to States Reporing Requirements and status reports	State Financial Status Report Final form 1	State Financial Status Report Final
IMLS Interim Performance Report Cover Sheet	IMLS-CLR-F-0026A	IMLS Interim Performance Report Cover Sheet
Library Reviewer form	FY16 Library Reviewer form 1	FY16 Library Reviewer form
Museum Reviewer form	FY16 Museum Reviewer form 1	FY16 Museum Reviewer
Program Information Form

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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	7,367	7,367	0	0	0	0
Annual Time Burden (Hours)	15,085	15,085	0	0	0	0
Annual Cost Burden (Dollars)	417,391	417,391	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: No

Burden Reduction Due to:

Short Statement: IMLS is requesting a change to a previously approved clearance in order to extract the IMLS Final Performance Report first page and the IMLS Interim Performance Report first page for additional submissions. The currently approved IMLS Final and Interim Performance Reports are for applicants FY16 forward. Awardees who received a grant FY15 and prior were required to submit only the cover sheet of both those reports. IMLS needs to extract the first page from each report as a standalone document for submission by awardees FY15 and before. This change is requesting the same expiration date of 07/31/2018.

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Annual Cost to Federal Government: $406,017

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? Yes

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

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Common Form ICR:  No

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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: 06/06/2016

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