Information Collection

HHS Checklist

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

Documents and Forms

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.