Information Collection

Annual Certification and Data Collection Report Form

IC 217988 under ICR 201708-1559-001 · OMB 1559-0046.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1559-0046 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 201508 - 2 Annual Certification and Data Collection Report Form	Form and Instruction
Instructions - CDFI Fund Annual Certification and Data Collection Report Form.docx	Instruction
201508 - 2 Certification Amendment Form Certification Amendment Form.docx	Form and Instruction
201708 Annual Certification and Data Collection Report Form Annual Certification and Data Collection Report Form (201708).pdf	Form and Instruction
CDFI Fund Glossary.docx CDFI Fund Glossary	IC Document

IC Title:

Annual Certification and Data Collection Report Form

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	201508 - 2	Certification Amendment Form	Certification Amendment Form.docx	Yes	Yes	Fillable Fileable Signable
Instruction			Instructions - CDFI Fund Annual Certification and Data Collection Report Form.docx	Yes	Yes	Fillable Fileable
Form and Instruction	201708	Annual Certification and Data Collection Report Form	Annual Certification and Data Collection Report Form (201708).pdf	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: 1,050

Number of Respondents for Small Entity: 50

Affected Public: Private Sector

Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,050	200	850
Annual IC Time Burden (Hours)	8,663	1,863	6,800
Annual IC Cost Burden (Dollars)	507,108	507,108	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
CDFI Fund Glossary	CDFI Fund Glossary.docx	08/24/2015

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