Information Collection

SIPPRA Grant Application, Recordkeeping and Reports

IC 234777 under ICR 201905-1505-001 · OMB 1505-0260.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1505-0260 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
SIPPRA NOFA 1-28-19 draft for Supporting Stmt.docx www.grants.gov	Other-Notice of Funding Availability
SIPPRA Outcome Val SIPPRA Outcome Valuation Workbook (word) SIPPRA Outcome Valuation Template 3.7.19 with PRA Statement.docx	Form
SIPPRA Outcome Val SIPPRA Outcome Valuation Workbook (Excel) SIPPRA Outcome Valuation Workbook 3.7.19 with PRA Statement.xlsx	Form

IC Title:

SIPPRA Grant Application, Recordkeeping and Reports

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Notice of Funding Availability			SIPPRA NOFA 1-28-19 draft for Supporting Stmt.docx	www.grants.gov	Yes	Yes	Fillable Fileable
Form	SIPPRA Outcome Valuation Workbook (word)	SIPPRA Outcome Valuation Workbook (word)	SIPPRA Outcome Valuation Template 3.7.19 with PRA Statement.docx		Yes	Yes	Fillable Fileable
Form	SIPPRA Outcome Valuation Workbook (Excel)	SIPPRA Outcome Valuation Workbook (Excel)	SIPPRA Outcome Valuation Workbook 3.7.19 with PRA Statement.xlsx		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 50

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	Previously Approved
Annual Number of Responses for this IC	120	120
Annual IC Time Burden (Hours)	2,190	2,190
Annual IC Cost Burden (Dollars)	9,145,000	9,145,000

Documents for IC

table that charts IC Documents
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.