Information Collection

Compliance Reporting and Recordkeeping

IC 241274 under ICR 202201-1505-005 · 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⚠️ Notice: This information collection may be referencing outdated material.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
Q4 2021 Template - 4003 and 4112 40034112 Combo Q4 2021 Template Questions_v1.pdf	Form
Q4 2021 Template - 4003 and 4112 40034112 Combo Q4 2021 Template Questions_v1.pdf	Form
Q4 2021 Template - 4003 Only 4003 Only Q4 2021 Template Questions_v1.pdf	Form
Q4 2021 Template - 4003 Only 4003 Only Q4 2021 Template Questions_v1.pdf	Form
Q4 2021 Template - 4112 Only 4112 Only Q4 2021 Template Questions_v1.pdf	Form
Q4 2021 Template - 4112 Only 4112 Only Q4 2021 Template Questions_v1.pdf	Form

Information Collection (IC) Details

View Information Collection (IC)

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	Form No.	Form Name	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
Form	NA	Q4 2021 Template - 4003 and 4112	40034112 Combo Q4 2021 Template Questions_v1.pdf	Yes	Yes	Fillable Fileable
Form	NA	Q4 2021 Template - 4003 Only	4003 Only Q4 2021 Template Questions_v1.pdf	Yes	Yes	Fillable Fileable
Form	NA	Q4 2021 Template - 4112 Only	4112 Only Q4 2021 Template Questions_v1.pdf	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

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	Previously Approved
Annual Number of Responses for this IC	2,800	2,800
Annual IC Time Burden (Hours)	11,900	11,900
Annual IC Cost Burden (Dollars)	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.