Information Collection

NTIA IIJA Digital Equity Planning Program Application Forms

IC 252974 under ICR 202211-0660-001 · OMB 0660-0046.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
NTIA IIJA Digital Equity Planning Program Application Forms	Form and Instruction
Budget Narrative Form for DE Planning Program NTIA IIJA Budget Narrative Form for DE Planning Program.docx	Form and Instruction
Budget Narrative Form for DE Planning Program NTIA IIJA Budget Narrative Form for DE Planning Program.docx	Form and Instruction
Detailed Budget Justification for DE Planning Program NTIA IIJA Detailed Budget Justification for DE Planning Program.xlsx	Form
Detailed Budget Justification for DE Planning Program NTIA IIJA Detailed Budget Justification for DE Planning Program.xlsx	Form
Additional Questions for DE Tribal Applicants Additional Form Questions for DE Tribal Portal Application.docx	Form
Additional Questions for DE Tribal Applicants Additional Form Questions for DE Tribal Portal Application.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	N/A	Budget Narrative Form for DE Planning Program	NTIA IIJA Budget Narrative Form for DE Planning Program.docx	Yes	Yes	Fillable Fileable
Form	N/A	Detailed Budget Justification for DE Planning Program	NTIA IIJA Detailed Budget Justification for DE Planning Program.xlsx	Yes	Yes	Fillable Fileable
Form	N/A	Additional Questions for DE Tribal Applicants	Additional Form Questions for DE Tribal Portal Application.docx	Yes	Yes	Fillable Fileable

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 550

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	550	250	300
Annual IC Time Burden (Hours)	4,455	3,255	1,200
Annual IC Cost Burden (Dollars)	212,636	167,072	45,564

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.