Investment Funds Application

Forms and Documents

Document Name	Status
Form DFC‐004 Investment Funds Application Form and Instruction	Modified
4 83-I Questionairre for OMB 004.pdf Supporting Statement B	2022-07-22
DFC-004 Supporting Statement.docx Supporting Statement A	2022-07-22

IC Document Collections

IC ID	Document Title	Status
236739	Investment Funds Application Form and Instruction	Modified

ICR Details

OMB Control No: 3015-0006	ICR Reference No: 202207-3015-005
Status: Received in OIRA	Previous ICR Reference No: 202202-3015-007
Agency/Subagency: DFC	Agency Tracking No: DFC‐004
Title: Investment Funds Application
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 07/22/2022

	Requested	Previously Approved
Expiration Date	36 Months From Approved	08/31/2022
Responses	150	150
Time Burden (Hours)	300	150
Cost Burden (Dollars)	22,500	11,250

---

Abstract: The Investment Funds Application will be the principal document used by the agency to determine the investor’s and the project’s eligibility for funding and will collect information for underwriting analysis.

---

Authorizing Statute(s): PL: Pub.L. 115 - 254 1401 Name of Law: The Better Utilization of Investments Leading to Development Act of 2018
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 30209	05/18/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 43799	07/22/2022
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Investment Funds Application	DFC‐004	Investment Funds Application

---

ICR Summary of Burden

	Total Request	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	150	150	0	0	0	0
Annual Time Burden (Hours)	300	150	0	150	0	0
Annual Cost Burden (Dollars)	22,500	11,250	0	11,250	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The new form estimated the time to take to fill out the form. Two hours is the amount of time it takes to fill out the form.

---

Annual Cost to Federal Government: $8,422

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 07/22/2022

---