OMB 83i

PAPERWORK REDUCTION ACT SUBMISSION
Please read the instructions before completing this form. For additional forms or assistance in completing this form, contact your
agency's Paperwork Clearance Officer. Send two copies of this form, the collection instrument to be reviewed, the Supporting
Statement, and any additional documentation to: Office of Information and Regulatory Affairs, Office of Management and Budget,
Docket Library, Room 10102, 725 17th Street NW, Washington, DC 20503.
1. AGENCY/SUBAGENCY ORIGINATING REQUEST

2. OMB CONTROL NUMBER

Department of Commerce / Census Bureau / Economic Reimbursable
Surveys Division

a.

3. TYPE OF INFORMATION COLLECTION (X one)

4. TYPE OF REVIEW REQUESTED (X one)
X

a. NEW COLLECTION

0518

b. NONE

a. REGULAR SUBMISSION
b. EMERGENCY - APPROVAL REQUESTED BY:

b. REVISION OF A CURRENTLY APPROVED COLLECTION

c. DELEGATED

c. EXTENSION OF A CURRENTLY APPROVED COLLECTION

X

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d. REINSTATEMENT, WITHOUT CHANGE, OF A PREVIOUSLY
APPROVED COLLECTION FOR WHICH APPROVAL HAS EXPIRED

5. SMALL ENTITIES
Will this information collection have a significant economic
impact on a substantial number of small entities?

e. REINSTATEMENT, WITH CHANGE, OF A PREVIOUSLY
APPROVED COLLECTION FOR WHICH APPROVAL HAS EXPIRED

YES
X NO
6. REQUESTED EXPIRATION DATE

X

f. EXISTING COLLECTION IN USE WITHOUT AN OMB CONTROL
NUMBER

a. THREE YEARS FROM APPROVAL DATE
b. OTHER:

7. TITLE

Data Collection Form for Reporting on Audits of States, Local Governments, Indian Tribes, Institutions of Higher Education, and Nonprofit
Organizations for Fiscal Periods Ending Dates in 2019, 2020, or 2021
8. AGENCY FORM NUMBER(S) (if applicable)
Form SF-SAC
9. KEYWORDS

10. ABSTRACT
Non-Federal entities (states, local governments, Indian tribes, institutions of higher education, and nonprofit organizations) that expend $750,000 or more in Federal
awards during their fiscal period are required by the Single Audit Act Amendments of 1996 and Uniform Guidance to have audits conducted of their Federal awards
and file the resulting reporting packages and data collection forms with the Federal Audit Clearinghouse (FAC). OMB has designated the Census Bureau as the FAC
to serve as the government-wide repository of record for Single Audit reports. The Single Audit process is a primary method Federal agencies and pass-through
entities use to provide oversight for Federal awards and reduce risk of non-compliance and improper payments.
11. AFFECTED PUBLIC (Mark primary with "P" and all others that apply with "X")
a. INDIVIDUALS OR HOUSEHOLDS

12. OBLIGATION TO RESPOND (Mark primary with "P" and all

a. VOLUNTARY

d. FARMS

others that apply with "X")

b. REQUIRED TO OBTAIN OR RETAIN BENEFITS
b. BUSINESS OR OTHER FOR-PROFIT
X e. FEDERAL GOVERNMENT
P c. MANDATORY
P f. STATE, LOCAL OR TRIBAL GOVERNMENT
P c. NOT-FOR-PROFIT INSTITUTIONS
13. ANNUAL REPORTING AND RECORDKEEPING HOUR BURDEN
14. ANNUALIZED COST TO RESPONDENTS (In thousands of dollars)
a. NUMBER OF RESPONDENTS
b. TOTAL ANNUAL RESPONSES
(1) Percentage of these responses collected electronically
c. TOTAL ANNUAL HOURS REQUESTED
d. CURRENT OMB INVENTORY
e. DIFFERENCE (+, -)
f.

EXPLANATION OF
DIFFERENCE:

(1) Program change (+, -)

80,000
40,000
100
1,711,600
0
1,711,600
1,711,600

a. TOTAL CAPITAL/STARTUP COSTS
c. TOTAL ANNUALIZED COST REQUESTED
d. CURRENT OMB INVENTORY
e. DIFFERENCE (+, -)
f.

(2) Adustment (+, -)

15. PURPOSE OF INFORMATION COLLECTION (Mark primary with

16. FREQUENCY OF RECORDKEEPING OR REPORTING (X all that apply)

"P" and all others that apply with "X")

X
X

b. PROGRAM EVALUATION

X

d. AUDIT

a. RECORDKEEPING

X

e. PROGRAM PLANNING
OR MANAGEMENT

X
P

f. RESEARCH
g. REGULATORY OR
COMPLIANCE

c. GENERAL PURPOSE STATISTICS

17. STATISTICAL METHODS
Does this information collection employ
statistical methods?
YES

OMB FORM 83-I, 10/95

X

NO

EXPLANATION OF DIFFERENCE:
(1) Program change (+, -)

(2) Adustment (+, -)

a. APPLICATION FOR BENEFITS

0.00

b. TOTAL ANNUAL COSTS (O&M)

X

b. THIRD PARTY DISCLOSURE

c. REPORTING:

X

(1) On Occasion

(2) Weekly

(4) Quarterly

(5) Semi-Annually

(7) Biennially

X

(8) Other (Describe)

(3) Monthly

X (6) Annually
fiscal period based

18. AGENCY CONTACT (Person who can best answer questions regarding the content of this
submission)
a. NAME

Mark Dixon

b. TELEPHONE NUMBER (Include area code)

301-763-7264

OMB CONTROL NUMBER

TITLE

Data Collection Form for Reporting on Audits of States, Local Governments, Indian Tribes,
Institutions of Higher Education, and Nonprofit Organizations for Fiscal Periods Ending Dates
in 2019, 2020, or 2021
19. CERTIFICATION FOR PAPERWORK REDUCTION ACT SUBMISSIONS
0607

0518

a. PROGRAM OFFICIAL CERTIFICATION (Internal DOC Use Only)
Type name

Date

Enrique Lamas, Performing the Non-Exclusive Duties and Functions of the Deputy Director, U.S. Census
Bureau

On behalf of this Federal agency, I certify that the collection of information encompassed by this request
complies with 5 CFR 1320.9.
NOTE: The text of 5 CFR 1320.9, and the related provisions of 5 CFR 1320.8(b)(3), appear at the end of the
instructions. The certification is to be made with reference to those regulatory provisions as set forth in the
instructions.
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 (see note in Item 19 of the instructions);
(i) If applicable, it uses effective and efficient statistical survey methodology; and
(j) It makes appropriate use of information technology.
If you are unable to certify compliance with any of these provisions, identify the item below and explain the
reason in Item 18 of the Supporting Statement.

b. SENIOR OFFICIAL OR DESIGNEE CERTIFICATION
Type name

Jennifer Jessup, Departmental Paperwork Clearance Officer
OMB FORM 83-I (BACK), 10/95

Date