Information Collection

Grant Report

IC 254635 under ICR 202207-0915-002 · OMB 0915-0298.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0298 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment B - Measures and Detail Sheets_Clean.docx	Other-Reporting Requirement/Performa
Attachment B - Measures and Detail Sheets_Clean.docx	Other-Reporting Requirement/Performa
Attachment B1 - Crosswalk Table.docx	Other-Crosswalk Table
Attachment B1 - Crosswalk Table.docx	Other-Crosswalk Table
Attachment C - Financial and Demographic Data Elements_Clean.docx	Other-Reporting Requirement/Performa
Attachment C - Financial and Demographic Data Elements_Clean.docx	Other-Reporting Requirement/Performa
Attachment D - Additional Data Elements_Clean.docx	Other-Reporting Requirement/Performa
Attachment D - Additional Data Elements_Clean.docx	Other-Reporting Requirement/Performa

IC Title:

Grant Report

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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-Reporting Requirement/Performance Measure	Attachment B - Measures and Detail Sheets_Clean.docx	Yes	Yes	Fillable Fileable
Other-Crosswalk Table	Attachment B1 - Crosswalk Table.docx	Yes	Yes	Fillable Fileable
Other-Reporting Requirement/Performance Measure	Attachment C - Financial and Demographic Data Elements_Clean.docx	Yes	Yes	Fillable Fileable
Other-Reporting Requirement/Performance Measure	Attachment D - Additional Data Elements_Clean.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 700

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
Annual Number of Responses for this IC	700	700
Annual IC Time Burden (Hours)	25,200	25,200
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.