OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Forms and Regulatons for Grants to States for Construction and Acquisition of State Home Facilities

IC 28939 under ICR 202302-2900-003 · OMB 2900-0661.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
Form 10-0388-14
Forms and Regulatons for Grants to States for Construction and Acquisition of State Home Facilities		 Form and Instruction
10-0388-14 VA Checklist of Major Requirements for State Homes Const
Form 10-0388-14 VA Checklist.pdf 		Form and Instruction
10-0388-1 Documents and Information Required for State Home Constr
Form 10-0388-1.pdf 		Form and Instruction
10-0388-2 Certification of Compliance with Provisions of the Davis
Form 10-0388-2 Davis-Bacon Act.pdf 		Form
10-0388-3 State Home Construction Grant Program Space Program Anal
Form 10-0388-3 Space Program Analysis-Nursing Home and Domiciliary (1).pdf 		Form
10-0388-4 Sate Home Construction Grant Program Space Program Analy
Form 10-0388-4 Space Program Analysis-Adult day Health Care (1).pdf 		Form
10-0388-5 Additional Documents and Information Required for State
Form 10-0388-5.pdf 		Form
10-0388-6 Certification of State Matching Funds To Qualify for Gro
Form 10-0388-6 State Matching Funds.pdf 		Form
10-0388-7 Certification Regarding Debarment, Suspension, and Other
Form 10-0388-7 Certification Regarding Debarment, Suspension and Other Responsibilities.pdf 		Form and Instruction
10-0388-8 Certification Regarding Drug-Free Workplace Requirements
Form 10-0388-8 Certification Re. Drug-Free Workplace.pdf 		Form
10-0388-9 Certification Regarding Lobbying
Form 10-0388-9 Certification Re. Lobbying.pdf 		Form
10-0388-10 Certification of Compliance With Federal Requirements -
Form 10-0388-10 Certification of Compliance with Federal Requirements.pdf 		Form
10-0388-12 Certification Regarding Debarment, Suspension, Ineligibi
Form 10-0388-12.pdf 		Form and Instruction
10-0388-13 Documents and Information Required for State Home Constr
Form 10-0388-13.pdf 		Form

Information Collection (IC) Details

View Information Collection (IC)

layout table

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 and Instruction 10-0388-14 VA Checklist of Major Requirements for State Homes Construction/Acquisition Grants Form 10-0388-14 VA Checklist.pdf Yes No Fillable Printable
Form and Instruction 10-0388-1 Documents and Information Required for State Home Construction and Acquisition Grants - Initial Application Form 10-0388-1.pdf Yes No Fillable Printable
Form 10-0388-2 Certification of Compliance with Provisions of the Davis-Bacon Act Form 10-0388-2 Davis-Bacon Act.pdf Yes No Fillable Printable
Form 10-0388-3 State Home Construction Grant Program Space Program Analysis - Nursing Home & Domiciliary Form 10-0388-3 Space Program Analysis-Nursing Home and Domiciliary (1).pdf Yes No Fillable Printable
Form 10-0388-4 Sate Home Construction Grant Program Space Program Analysis - Adult Day Care Form 10-0388-4 Space Program Analysis-Adult day Health Care (1).pdf Yes No Fillable Printable
Form 10-0388-5 Additional Documents and Information Required for State Home Construction and Acquisition Grants Application Form 10-0388-5.pdf Yes No Fillable Printable
Form 10-0388-6 Certification of State Matching Funds To Qualify for Group 1 on the Priority List Form 10-0388-6 State Matching Funds.pdf Yes No Fillable Printable
Form and Instruction 10-0388-7 Certification Regarding Debarment, Suspension, and Other Responsibility Matters - Primary Covered Transactions Form 10-0388-7 Certification Regarding Debarment, Suspension and Other Responsibilities.pdf Yes No Fillable Printable
Form 10-0388-8 Certification Regarding Drug-Free Workplace Requirements for Grantees Other Than Individuals Form 10-0388-8 Certification Re. Drug-Free Workplace.pdf Yes No Fillable Printable
Form 10-0388-9 Certification Regarding Lobbying Form 10-0388-9 Certification Re. Lobbying.pdf Yes No Fillable Printable
Form 10-0388-10 Certification of Compliance With Federal Requirements - State Home Construction Grant Form 10-0388-10 Certification of Compliance with Federal Requirements.pdf Yes No Fillable Printable
Form and Instruction 10-0388-12 Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - Lower Tier Covered Transactions Form 10-0388-12.pdf Yes No Fillable Printable
Form 10-0388-13 Documents and Information Required for State Home Construction and Acquisition Grants - Post-Grant Requirements Form 10-0388-13.pdf Yes No Fillable Printable

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 50 0 0 0 50 0
Annual IC Time Burden (Hours) 1,200 0 0 0 1,200 0
Annual IC Cost Burden (Dollars) 0 0 0 0 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.