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

Federal and Non-Federal Financial Assistance Instruments

Documents and Forms

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

Information Collection (IC) Details

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

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 %

	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

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.