Information Collection

HHS Checklist

IC 212214 under ICR 202211-1660-004 · OMB 1660-0085.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form HHS-5161-1 HHS Checklist	Form
HHS-5161-1 Checklist HHS CheckList,.pdf www.grants.gov/web/grants/forms/sf-424-family.html#sortby=1	Form
HHS-5161-1 Checklist HHS CheckList,.pdf www.grants.gov/web/grants/forms/sf-424-family.html#sortby=1	Form

IC Title:

HHS Checklist

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 44 CFR 206.171

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	HHS-5161-1	Checklist	HHS CheckList,.pdf	http://www.grants.gov/web/grants/forms/sf-424-family.html#sortby=1	Yes	Yes	Fillable Printable

Line of Business: Disaster Management

Subfunction: Disaster Preparedness and Planning

Privacy Act System of Records

Title: DHS/FEMA-009 â Hazard Mitigation Assistance Grant Programs

FR Citation: 77 FR 17783

Number of Respondents: 15

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
	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-15	15
Annual IC Time Burden (Hours)	-15	15
Annual IC Cost Burden (Dollars)	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.