Information Collection

Community Connectivity Initiative Self-Assessment Tool

IC 225102 under ICR 201701-0660-002 · OMB 0660-0040.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Community Connectivity Initiative Self-Assessment Tool	Form
Community Connectivity Initiative Self-Assessment Tool CCI Modules 1.5.17.docx	Form
83i-form Assessment Tool.pdf CCI Tool Form 83i	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

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
Form	n/a	Community Connectivity Initiative Self-Assessment Tool	CCI Modules 1.5.17.docx		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 500

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	500	500
Annual IC Time Burden (Hours)	6,000	6,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
CCI Tool Form 83i	83i-form Assessment Tool.pdf	01/11/2017

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