NBAM Online Data Collection Form

NTIA Voluntary Collection of Broadband Availability Data

Documents and Forms

Document Name Document Type
NBAM Data Submission Guidelines.docx Instruction
NBAM Online Data Collection Form NBAM Online Data Collection Form.docx Form

Information Collection (IC) Details

IC Title:	NBAM Online Data Collection Form	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
Instruction			NBAM Data Submission Guidelines.docx		Yes	Yes	Fillable Fileable
Form	n/a	NBAM Online Data Collection Form	NBAM Online Data Collection Form.docx		Yes	Yes	Fillable Fileable

Line of Business: Economic Development

Subfunction: Business and Industry Development

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 600	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,200	1,200
Annual IC Time Burden (Hours)	63,600	63,600
Annual IC Cost Burden (Dollars)	3,067,020	3,067,020

Documents for IC

Title	Document	Date Uploaded
No associated records found

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