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INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-I: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
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TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
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| Federal and Non-Federal Financial Assistance Instruments |
0596-0217 |
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| DATE PREPARED |
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| February 7, 2023 |
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| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
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ANNUAL BURDEN |
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REPORTS |
RECORDS |
RESPONDENT COST |
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TOTAL |
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FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
COST |
TOTAL |
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| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
PER |
COST |
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| REGS. |
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so state) |
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PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
HOUR |
(Col. H x L) |
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RESPONDENT |
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KEEPER |
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(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
(L) |
(M) |
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| 0596-0217 |
Modification Form |
FS-1500-19 |
7,893 |
1.00 |
7,893 |
0.30 |
2,368 |
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0.00 |
0.00 |
$0.00 |
G& A Face Sheet |
| 0596-0217 |
Cooperator Performance Report (Optional Template) |
FS-1500-23 |
4,293 |
2.00 |
8,586 |
2.00 |
17,172 |
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0.00 |
0.00 |
$0.00 |
| 0596-0217 |
Grant or Agreement Award Face Sheet |
FS-1500-100 |
1,270 |
1.00 |
1,270 |
3.00 |
3,810 |
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0.00 |
0.00 |
$0.00 |
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TOTAL: |
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13,456 |
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17,749 |
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23,350 |
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0.00 |
38.80 |
$905,976.12 |
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FEDERAL FINANCIAL ASSISTANCE TEMPLATES |
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0.00 |
. |
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NEW FORMS AND COLLECTIONS |
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0.00 |
0.00 |
$0.00 |
State, Local and Tribal |
| 0596-0217 |
Certification Regarding Lobbying (Required for all awards over $100K) |
FS-1500-35 |
318 |
1.00 |
318 |
0.15 |
48 |
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0.00 |
0.00 |
$0.00 |
| 0596-0217 |
Financial Capability Questionnaire |
FS-1500-22 |
200 |
1.00 |
200 |
1.00 |
200 |
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0.00 |
0.00 |
$0.00 |
| 0596-0217 |
Financial Capability Checklist |
FS-1500-22A |
550 |
1.00 |
550 |
0.50 |
275 |
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0.00 |
0.00 |
$0.00 |
| 0596-0217 |
Financial Capability Checklist (States ONLY) |
FS-1500-22B |
50 |
1.00 |
50 |
0.50 |
25 |
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0.00 |
0.00 |
$0.00 |
| 0596-0217 |
Equipment Justification and Certification Statement |
FS-1500-34 |
25 |
1.00 |
25 |
0.42 |
11 |
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0.00 |
0.00 |
$0.00 |
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TOTAL: |
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1,143 |
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1,143 |
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558 |
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0.00 |
35.91 |
$20,044.96 |
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NONFEDERAL FINANCIAL ASSISTANCE TEMPLATES |
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0.00 |
0.00 |
$0.00 |
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| 0596-0217 |
COOPERATIVE FIRE AGREEMENTS |
FS-1500-7 |
225 |
1.00 |
225 |
3.00 |
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0.00 |
0.00 |
$0.00 |
Private Sector |
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SUB TOTAL: |
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225 |
1.00 |
225 |
3.00 |
675 |
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0.00 |
0.00 |
$0.00 |
| 0596-0217 |
LAW ENFORCEMENT AGREEMENTS |
FS-1500-8 |
87 |
1.00 |
87 |
3.00 |
261 |
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0.00 |
0.00 |
$0.00 |
| 0596-0217 |
Cooperative Law Enforcement Annual Operating Plan and Financial Plan |
FS-1500-8A |
87 |
1.00 |
87 |
3.00 |
261 |
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0.00 |
0.00 |
$0.00 |
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SUB TOTAL: |
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174 |
1.00 |
174 |
6.00 |
522 |
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0.00 |
0.00 |
$0.00 |
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ROADS AGREEMENTS |
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0.00 |
0.00 |
$0.00 |
| 0596-0217 |
Cooperative Forest Road Agreement |
FS-1500-9 |
103 |
1.00 |
103 |
4.00 |
412 |
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0.00 |
0.00 |
$0.00 |
| 0596-0217 |
Road Project Agreement |
FS-1500-9A |
103 |
1.00 |
103 |
4.00 |
412 |
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0.00 |
0.00 |
$0.00 |
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SUB TOTAL: |
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206 |
1.00 |
206 |
8.00 |
824 |
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0.00 |
0.00 |
$0.00 |
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COLLECTION AGREEMENTS |
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0.00 |
0.00 |
$0.00 |
| 0596-0217 |
Collection Agreement |
FS-1500-11 |
244 |
1.00 |
244 |
4.00 |
976 |
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0.00 |
0.00 |
$0.00 |
| 0596-0217 |
Reimbursable Collection Agreement, Rocky Mountain Elk Foundation |
FS-1500-11A |
244 |
1.00 |
244 |
4.00 |
976 |
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0.00 |
0.00 |
$0.00 |
| 0596-0217 |
Advance Collection Agreement, Rocky Mountain Elk Foundation |
FS-1500-11B |
244 |
1.00 |
244 |
4.00 |
976 |
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0.00 |
0.00 |
$0.00 |
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SUB TOTAL: |
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732 |
1.00 |
732 |
12.00 |
2,928 |
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0.00 |
0.00 |
$0.00 |
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MEMORANDUM OF UNDERSTANDING |
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0.00 |
0.00 |
$0.00 |
| 0596-0217 |
Memorandum of Understanding |
FS-1500-15 |
150 |
1.00 |
150 |
3.00 |
450 |
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0.00 |
0.00 |
$0.00 |
| 0596-0217 |
Memorandum of Understanding for Cooperative Frequency Usage |
FS-1500-15A |
150 |
1.00 |
150 |
3.00 |
450 |
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0.00 |
0.00 |
$0.00 |
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SUB TOTAL: |
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300 |
1.00 |
300 |
6.00 |
900 |
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0.00 |
0.00 |
$0.00 |
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PARTICIPATING AGREEMENTS |
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0.00 |
0.00 |
$0.00 |
| 0596-0217 |
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Master Stewardship Agreement |
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FS 1500-21 |
54 |
1.00 |
54 |
4.00 |
216 |
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0.00 |
0.00 |
$0.00 |
| 0596-0217 |
Stewardship Agreement Supplemental Project Agreement |
FS-1500-21A |
54 |
1.00 |
54 |
4.00 |
216 |
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0.00 |
0.00 |
$0.00 |
| 0596-0217 |
Stewardship Agreement Financial Plan |
FS-1500-21B |
54 |
1.00 |
54 |
4.00 |
216 |
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0.00 |
0.00 |
$0.00 |
| 0596-0217 |
Stewardship Agreement |
FS-1500-21C |
54 |
1.00 |
54 |
4.00 |
216 |
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0.00 |
0.00 |
$0.00 |
| 0596-0217 |
Stewardship Agreement (Short Form) |
FS-1500-21D |
54 |
1.00 |
54 |
4.00 |
216 |
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0.00 |
0.00 |
$0.00 |
| 0596-0217 |
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Agreements Financial Plan (Long) Optional |
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FS-1500-17A |
54 |
1.00 |
54 |
4.00 |
216 |
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0.00 |
0.00 |
$0.00 |
| 0596-0217 |
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Agreements Financial Plan (Short) Optional |
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FS-1500-17B |
54 |
1.00 |
54 |
4.00 |
216 |
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0.00 |
0.00 |
$0.00 |
| 0596-0217 |
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Agreements Financial Plan (Medium Form) Optional |
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FS-1500-17C |
54 |
1.00 |
54 |
4.00 |
216 |
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0.00 |
0.00 |
$0.00 |
| 0596-0217 |
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Collection Agreement Financial Plan Optional |
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FS-1500-18 |
298 |
1.00 |
298 |
4.00 |
1,192 |
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0.00 |
0.00 |
$0.00 |
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SUB TOTAL: |
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730 |
1.00 |
730 |
36.00 |
2,920 |
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0.00 |
0.00 |
$0.00 |
| 0596-0217 |
Good Neighbor Agreement |
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FS-1500-36 |
5 |
1.00 |
5 |
4.50 |
23 |
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0.00 |
0.00 |
$0.00 |
| 0596-0217 |
Master Good Neighbor Agreement |
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FS-1500-36A |
5 |
1.00 |
5 |
4.50 |
23 |
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0.00 |
0.00 |
$0.00 |
| 0596-0217 |
Supplemental Good Neighbor Agreement |
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FS-1500-36B |
5 |
1.00 |
5 |
4.50 |
23 |
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0.00 |
0.00 |
$0.00 |
| 0596-0217 |
Good Neighbor Agreement (Road Work and Other Activities) |
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FS-1500-37 |
5 |
1.00 |
5 |
4.50 |
23 |
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0.00 |
0.00 |
$0.00 |
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SUB TOTAL: |
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20 |
1.00 |
20 |
18.00 |
90 |
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0.00 |
0.00 |
$0.00 |
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TOTAL: |
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2,387 |
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2,387 |
12.71 |
8,859 |
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0.00 |
38.80 |
$343,729.20 |
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Grand TOTAL: |
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16,986 |
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21,279 |
13 |
32,767 |
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$1,269,750.28 |
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