Information Collection

Local Government Certifications

IC 241157 under ICR 202005-1505-004 · OMB 1505-0264.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1505-0264 can be found here:

Documents and Forms

Document Name Document Type
Local Government Certifications Form and Instruction
Government Certifications 1505-0264 - Certification for CARES Act-Title V Coronavirus Relief Funds 4-11-20.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Local Government Certifications	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	n/a	Government Certifications	1505-0264 - Certification for CARES Act-Title V Coronavirus Relief Funds 4-11-20.docx		Yes	Yes	Fillable Fileable

Line of Business: Disaster Management

Subfunction: Disaster Repair and Restore

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 200	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	200	200
Annual IC Time Burden (Hours)	400	400
Annual IC Cost Burden (Dollars)	0	0

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.