Information Collection

Jobs Plus Pilot Program

IC 212823 under ICR 202205-2577-002 · OMB 2577-0281.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2577-0281 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SF-424 Jobs Plus Pilot Program	Form and Instruction
sf424b_non-contstruct_programs 2.1.22.pdf	Instruction
sf424b_non-contstruct_programs 2.1.22.pdf	Instruction
SF-424 Application for Federal Assistance SF424.pdf	Form and Instruction
SF-424 Application for Federal Assistance SF424.pdf	Form and Instruction
SF-LLL Disclosure of Lobbying Activities SF-LLL.pdf	Form and Instruction
SF-LLL Disclosure of Lobbying Activities SF-LLL.pdf	Form and Instruction
HUD-2880 Application/Recipient Disclosure/Update Report HUD-2880.pdf	Form and Instruction
HUD-2880 Application/Recipient Disclosure/Update Report HUD-2880.pdf	Form and Instruction
HUD-50144 Summary Job Plus Budget Form HUD-50144.xls	Form and Instruction
HUD-50144 Summary Job Plus Budget Form HUD-50144.xls	Form and Instruction
HUD 2991 Certification of Consistency witth the Consolidated Plan HUD2991 2.1.pdf	Form and Instruction
HUD 2991 Certification of Consistency witth the Consolidated Plan HUD2991 2.1.pdf	Form and Instruction
HUD 50153 Certification of Consistency with Promise Zone Goals and HUD50153 PZ 2.1.22.pdf	Form and Instruction
HUD 50153 Certification of Consistency with Promise Zone Goals and HUD50153 PZ 2.1.22.pdf	Form and Instruction
SF 425 Federal Financial Report SF425_3_0-V3.0 2.1.22.pdf	Form and Instruction
SF 425 Federal Financial Report SF425_3_0-V3.0 2.1.22.pdf	Form and Instruction

IC Title:

Jobs Plus Pilot Program

Agency IC Tracking Number:

2577-NEW

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
Form and Instruction	SF-424	Application for Federal Assistance	SF424.pdf	Yes	Yes	Fillable Printable
Form and Instruction	SF-LLL	Disclosure of Lobbying Activities	SF-LLL.pdf	Yes	Yes	Fillable Fileable Signable
Form and Instruction	HUD-2880	Application/Recipient Disclosure/Update Report	HUD-2880.pdf	Yes	Yes	Fillable Fileable Signable
Form and Instruction	HUD-50144	Summary Job Plus Budget	Form HUD-50144.xls	Yes	Yes	Fillable Printable
Form and Instruction	HUD 2991	Certification of Consistency witth the Consolidated Plan	HUD2991 2.1.pdf	Yes	Yes	Fillable Fileable Signable
Form and Instruction	HUD 50153	Certification of Consistency with Promise Zone Goals and Implementation	HUD50153 PZ 2.1.22.pdf	Yes	Yes	Fillable Fileable Signable
Instruction			sf424b_non-contstruct_programs 2.1.22.pdf	Yes	Yes	Fillable Fileable Signable
Form and Instruction	SF 425	Federal Financial Report	SF425_3_0-V3.0 2.1.22.pdf	Yes	Yes	Fillable Fileable Signable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 103

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	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	103	28	75
Annual IC Time Burden (Hours)	6,573	-830	7,403
Annual IC Cost Burden (Dollars)	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.