Information Collection

NTIA IIJA Middle Mile Grant Program Application Forms

IC 252956 under ICR 202211-0660-001 · OMB 0660-0046.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
NTIA IIJA Middle Mile Grant Program Application Forms	Form and Instruction
Budget Narrative Form for MMG Program NTIA IIJA Budget Narrative Form for MMG Program.docx	Form and Instruction
Budget Narrative Form for MMG Program NTIA IIJA Budget Narrative Form for MMG Program.docx	Form and Instruction
Community Anchor Institution List Form NTIA IIJA Community Anchor Institution List Form.xlsx	Form
Community Anchor Institution List Form NTIA IIJA Community Anchor Institution List Form.xlsx	Form
Detailed Budget Justification for MMG Program NTIA IIJA Detailed Budget Justification for Middle Mile Program.xlsx	Form
Detailed Budget Justification for MMG Program NTIA IIJA Detailed Budget Justification for Middle Mile Program.xlsx	Form
Pro Forma Financial Projection Form NTIA IIJA Pro Forma Financial Projection Form.xlsx	Form
Pro Forma Financial Projection Form NTIA IIJA Pro Forma Financial Projection Form.xlsx	Form
Table of Funded and Unfunded Collaborators NTIA IIJA Table of Funded Part. and Unfunded Collaborators.xlsx	Form
Table of Funded and Unfunded Collaborators NTIA IIJA Table of Funded Part. and Unfunded Collaborators.xlsx	Form
MMG Project Questions NTIA IIJA MMG Project Questions (UPDATED).docx	Form and Instruction
MMG Project Questions NTIA IIJA MMG Project Questions (UPDATED).docx	Form and Instruction

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	N/A	Budget Narrative Form for MMG Program	NTIA IIJA Budget Narrative Form for MMG Program.docx	Yes	Yes	Fillable Fileable
Form	N/A	Community Anchor Institution List Form	NTIA IIJA Community Anchor Institution List Form.xlsx	Yes	Yes	Fillable Fileable
Form	N/A	Detailed Budget Justification for MMG Program	NTIA IIJA Detailed Budget Justification for Middle Mile Program.xlsx	Yes	Yes	Fillable Fileable
Form	N/A	Pro Forma Financial Projection Form	NTIA IIJA Pro Forma Financial Projection Form.xlsx	Yes	Yes	Fillable Fileable
Form	N/A	Table of Funded and Unfunded Collaborators	NTIA IIJA Table of Funded Part. and Unfunded Collaborators.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	N/A	MMG Project Questions	NTIA IIJA MMG Project Questions (UPDATED).docx	Yes	Yes	Fillable Fileable

Line of Business: General Government

Subfunction: Executive Functions

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	Previously Approved
Annual Number of Responses for this IC	700	50	650
Annual IC Time Burden (Hours)	9,800	1,350	8,450
Annual IC Cost Burden (Dollars)	467,754	101,122	366,632

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.