Information Collection

Community Connectivity Initiative Self-Assessment Tool

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

Documents and Forms

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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Community Connectivity Initiative Self-Assessment Tool	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection 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 %

	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

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.