SF-424 Individual

Forms and Documents

Document Name	Status
Form 4040-0005 SF-424 Individual Burden Estimate Form	Modified
4040-0005 ICR SS.docx Supporting Statement A	2016-09-08

IC Document Collections

IC ID	Document Title	Status
186774	SF-424 Individual Burden Estimate Form	Modified

ICR Details

OMB Control No: 4040-0005	ICR Reference No: 201608-4040-011
Status: Historical Active	Previous ICR Reference No: 201210-4040-001
Agency/Subagency: EGOV	Agency Tracking No: 17342
Title: SF-424 Individual
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  Yes
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/01/2016
	Date Received in OIRA: 09/16/2016
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2019	36 Months From Approved	11/02/2016
Responses	0	0	1
Time Burden (Hours)	0	0	1
Cost Burden (Dollars)	0	0	0

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Abstract: The SF-424 Individual form supports the streamlined application requirements for individuals and reduces the administrative burden with a standard government-wide application form.

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Authorizing Statute(s): US Code: 31 USC 6301-6308 Name of Law: null
  

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:
	81 FR 9487	02/25/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 40322	06/20/2016
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
SF-424 Individual Burden Estimate	4040-0005	Application for Federal Assistance SF-424 Individual

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ICR Summary 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	0	1	0	-1	0	0
Annual Time Burden (Hours)	0	1	0	-1	0	0
Annual Cost Burden (Dollars)	0	0	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: This form is only used by National Endowment of the Arts and National Endowment of the Humanities. This form is not used by HHS. The discrepancy may have occurred based on incorrect usage of the form by an HHS sub-agency.

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Annual Cost to Federal Government: $0

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? No

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:  Yes

OIRA authorizes any Agency to begin using a Common Form associated with this ICR automatically after 5 calendar days from the date the agency's RCF including the common form was received in OIRA.

Description/Changes for Common Form Usage:  This meets the definition of a common form is used by more than one Federal grant-making agency. This is a standard form as it is required by all applicants to apply for Federal grants.

Approved RCFs using this ICR

Agency/Sub Agency	RCF ID	RCF Title	RCF Status	IC Title
TREAS/CDFIF	201612-1559-002CF	CDFI SF-424 Individual Form Use	Historical Active	SF-424 Individual Burden Estimate
USDA/RUS	201612-0572-010CF	SF-424 Application for Federal Assistance - Individual	Historical Active	SF-424 Individual Burden Estimate
USDA/RBS	201612-0570-012CF	Rural Microentrepreneur Assistance Program	Historical Active	SF-424 Individual Burden Estimate
USDA/RBS	201612-0570-013CF	Small Socially-Disadvantaged Producer Grant Programs	Historical Active	SF-424 Individual Burden Estimate
USDA/RHS	201612-0575-013CF	7 CFR 1942-A, Community Facilities Loans	Historical Active	SF-424 Individual Burden Estimate
USDA/NIFA	201612-0524-058CF	SF 424 Discretionary	Historical Active	SF-424 Individual Burden Estimate
DOT/FTA	201612-2132-016CF	Application for Federal Assistance SF-424	Historical Active	SF-424 Individual Burden Estimate
DOT/FTA	201612-2132-017CF	Application for Federal Assistance SF-424	Historical Active	SF-424 Individual Burden Estimate
DOT/FTA	201612-2132-018CF	Application for Federal Assistance SF-424	Historical Active	SF-424 Individual Burden Estimate
DOT/FTA	201612-2132-019CF	Application for Federal Assistance SF-424	Historical Active	SF-424 Individual Burden Estimate
DOI/FWS	201807-1018-006CF	SF-424 Individual form usage for USFWS	Historical Active	SF-424 Individual Burden Estimate
USDA/FS	201802-0596-006CF	Application for Federal Assistance (SF-424) (Individual)	Historical Active	SF-424 Individual Burden Estimate

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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: 09/16/2016

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