Information Collection

CHIPS Pre-Application Information Collection

IC 258881 under ICR 202303-0693-003 · OMB 0693-0095.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0693-0095 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Instrument Placeholder.docx	Other-Placeholder
2023-02-23 Pre-App Financial Model White Paper vF.docx	Other-Financial Model White Paper
2023-03-21 Pre-app Emer PRA Screen Shots v2.pdf	Other-Pre-App Screen Shots
20230223 - Simple Financial Model_v24.xlsx	Other-Simple Financial Model
20230302 - Pre-Application Offline Template - Sources & Uses vUpdated.xlsx	Other-Pre-Application Sources and Us
20230321 CHIPS Pre-App Instruction Guide vJP.docx	Other-PRe-Application Instructions G
CHIPS Pre Application Supporting Statement 2023-02-25 v2.5 - FALD - CLEAN.docx Supporting Statement	IC Document
Published FRN CHIPS Pre Application.pdf Published FRN	IC Document
Published FRN CHIPS Pre Application.pdf Published FRN	IC Document
CHIPS Pre Application Supporting Statement A CLEAN.docx Supporting Statement A	IC Document
Supporting Statement B for pre application 3_23_23.docx Supporting Statement B	IC Document
CHIPS Pre-Application Emergency Justification.pdf Emergency Justification	IC Document

IC Title:

CHIPS Pre-Application Information Collection

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Financial Model White Paper	2023-02-23 Pre-App Financial Model White Paper vF.docx	Yes	Yes	Fillable Fileable
Other-Pre-App Screen Shots	2023-03-21 Pre-app Emer PRA Screen Shots v2.pdf	Yes	Yes	Fillable Fileable
Other-Simple Financial Model	20230223 - Simple Financial Model_v24.xlsx	Yes	Yes	Fillable Printable
Other-Pre-Application Sources and Uses Offline Template	20230302 - Pre-Application Offline Template - Sources & Uses vUpdated.xlsx	Yes	Yes	Fillable Printable
Other-PRe-Application Instructions Guide	20230321 CHIPS Pre-App Instruction Guide vJP.docx	Yes	Yes	Fillable Printable

Line of Business: Economic Development

Subfunction: Business and Industry Development

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 140

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	140	140
Annual IC Time Burden (Hours)	8,400	8,400
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Published FRN	Published FRN CHIPS Pre Application.pdf	03/03/2023
Supporting Statement A	CHIPS Pre Application Supporting Statement A CLEAN.docx	03/24/2023
Supporting Statement B	Supporting Statement B for pre application 3_23_23.docx	03/24/2023
Emergency Justification	CHIPS Pre-Application Emergency Justification.pdf	03/24/2023

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.