Request for Extension Form

Coronavirus State and Local Fiscal Recovery Funds Program

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1505-0271 can be found here:

Documents and Forms

Document Name Document Type
Request for Extension Form Form
Request for Extension First-NEU-Extension-Form_updated.docx Form
Request for Extension First-NEU-Extension-Form_updated.docx Form
Request for Second Extension Subsequent-NEU-Extension-Form_2ndtranche.docx Form
Request for Second Extension Subsequent-NEU-Extension-Form_2ndtranche.docx Form

Information Collection (IC) Details

IC Title:	Request for Extension Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	N/A	Request for Extension	First-NEU-Extension-Form_updated.docx		Yes	Yes	Fillable Fileable
Form	N/A	Request for Second Extension	Subsequent-NEU-Extension-Form_2ndtranche.docx		Yes	Yes	Fillable Fileable

Line of Business: General Government

Subfunction: Central Fiscal Operations

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 55	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	96	96
Annual IC Time Burden (Hours)	96	96
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.