CHIPS Pre-Application Information Collection

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.