Information Collection

State, Local, and Tribal Govt. - Federal and Non-Federal Financial Assistance Instruments

IC 185951 under ICR 202210-0596-001 · OMB 0596-0217.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form FS-1500-22 State, Local, and Tribal Govt. - Federal and Non-Federal Financial Assistance Instruments	Form and Instruction
FS-1500-22 Financial Capability Questionaire FS 1500-22 Financial Capability Questionaire 2.0_v1.docx	Form and Instruction
FS-1500-22b Financial Capability Checklist for State Government Agen FS-1500-22b Financial Capability Checklist for State Government Agencies_v1.docx	Form
FS-1500-34 Grant Equipment Justification and Certification Statemen FS-1500-34 Grant Equipment Justification and Certification Statement_v1.docx	Form
FS-1500-35 Certification Regarding Lobbying FS-1500-35 Certification Regarding Lobbying_v1.docx	Form
FS-1500-22A Financial Capability Checklist FS-1500-22a Financial Capability Checklist_v1.docx	Form

IC Title:

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
Form and Instruction	FS-1500-22	Financial Capability Questionaire	FS 1500-22 Financial Capability Questionaire 2.0_v1.docx	Yes	Yes	Fillable Printable
Form	FS-1500-22b	Financial Capability Checklist for State Government Agencies Only	FS-1500-22b Financial Capability Checklist for State Government Agencies_v1.docx	Yes	Yes	Fillable Printable
Form	FS-1500-34	Grant Equipment Justification and Certification Statement	FS-1500-34 Grant Equipment Justification and Certification Statement_v1.docx	Yes	Yes	Fillable Printable
Form	FS-1500-35	Certification Regarding Lobbying	FS-1500-35 Certification Regarding Lobbying_v1.docx	Yes	Yes	Paper Only
Form	FS-1500-22A	Financial Capability Checklist	FS-1500-22a Financial Capability Checklist_v1.docx	No		Paper Only

Line of Business: General Government

Subfunction: Central Fiscal Operations

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,143

Number of Respondents for Small Entity: 404

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,143	-861	2,004
Annual IC Time Burden (Hours)	558	-16,837	17,395
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.