Information Collection

Compliance Reporting and Recordkeeping

IC 241274 under ICR 202111-1505-004 · OMB 1505-0263.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1505-0263 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Baseline and Q3 Template Changes Screenshots 101420.docx	Other-Screenshots
Baseline and Q3 Template Changes Screenshots 101420.docx	Other-Screenshots
Q4 and Baseline 4112 Screenshots.pdf	Other-Screenshots
Q4 and Baseline 4112 Screenshots.pdf	Other-Screenshots
Q4 4003-only screenshots.pdf	Other-Screenshots
Q4 4003-only screenshots.pdf	Other-Screenshots
Q4 4112_4003 screenshots.pdf	Other-screenshots
Q4 4112_4003 screenshots.pdf	Other-screenshots
4003-4112 Combo Screenshots as of 05212021.pdf	Other-Screenshots
4003-4112 Combo Screenshots as of 05212021.pdf	Other-Screenshots
4112 Screenshots as of 05202021.pdf	Other-Screenshots
4112 Screenshots as of 05202021.pdf	Other-Screenshots
Q4 Baseline Screenshots as of 05192021.pdf	Other-Screenshots
Q4 Baseline Screenshots as of 05192021.pdf	Other-Screenshots
Q1 2021 4003 Only 05212021.pdf	Other-Screenshots
Q1 2021 4003 Only 05212021.pdf	Other-Screenshots
062921CARESActExecutiveCompInformationRequest_final.xlsx	Other-Template
062921CARESActExecutiveCompInformationRequest_final.xlsx	Other-Template
Additional Questions_PSP4003 Q3 2021_11.18.docx	Other-additional question set
Additional Questions_PSP4003 Q3 2021_11.18.docx	Other-additional question set

IC Title:

Compliance Reporting and Recordkeeping

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	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Screenshots	Baseline and Q3 Template Changes Screenshots 101420.docx	Yes	Yes	Fillable Fileable
Other-Screenshots	Q4 and Baseline 4112 Screenshots.pdf	Yes	Yes	Fillable Fileable
Other-Screenshots	Q4 4003-only screenshots.pdf	Yes	Yes	Fillable Fileable
Other-screenshots	Q4 4112_4003 screenshots.pdf	Yes	Yes	Fillable Fileable
Other-Screenshots	4003-4112 Combo Screenshots as of 05212021.pdf	Yes	Yes	Fillable Fileable
Other-Screenshots	4112 Screenshots as of 05202021.pdf	Yes	Yes	Fillable Fileable
Other-Screenshots	Q4 Baseline Screenshots as of 05192021.pdf	Yes	Yes	Fillable Fileable
Other-Screenshots	Q1 2021 4003 Only 05212021.pdf	Yes	Yes	Fillable Fileable
Other-Template	062921CARESActExecutiveCompInformationRequest_final.xlsx	Yes	Yes	Fillable Fileable
Other-additional question set	Additional Questions_PSP4003 Q3 2021_11.18.docx	Yes	Yes	Fillable Fileable

Line of Business: Economic Development

Subfunction: Industry Sector Income Stabilization

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 700

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	2,800	0	-1,600	4,400
Annual IC Time Burden (Hours)	11,900	700	-6,400	17,600
Annual IC Cost Burden (Dollars)	0	0	0	0

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.