CAP Site Questionnaire Form

IMLS Collections Assessment for Preservation Forms

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3137-0126 can be found here:

Documents and Forms

Document Name Document Type
Form CAP Site Questionn CAP Site Questionnaire Form Form and Instruction
CAP Site Questionn CAP Site Questionnaire Form CAP Site Questionnaire Form-20210309.docx Form and Instruction
CAP Site Questionn CAP Site Questionnaire Form CAP Site Questionnaire Form-20210309.docx Form and Instruction

Information Collection (IC) Details

IC Title:	CAP Site Questionnaire 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
Form and Instruction	CAP Site Questionnaire Form 1	CAP Site Questionnaire Form	CAP Site Questionnaire Form-20210309.docx		Yes	Yes	Fillable Fileable

Line of Business: Education

Subfunction: Cultural and Historic Preservation

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 100	Number of Respondents for Small Entity: 80

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	400	400
Annual IC Cost Burden (Dollars)	11,372	11,372

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.