Information Collection

Application Form

IC 264363 under ICR 202401-0660-001 · OMB 0660-0054.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Application Form	Form and Instruction
State Digital Equity Capacity Grant Program Application 1.4.24 DRAFT_DE Capacity Application_Application Form_State Terr (1) (1).xlsx	Form and Instruction
State Digital Equity Capacity Grant Program Application 2.5.24 DRAFT_DE Capacity Application_Application Form_State Terr.xlsx	Form and Instruction

IC Title:

Application Form

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

CFR Citation:

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	N/A	State Digital Equity Capacity Grant Program Application	2.5.24 DRAFT_DE Capacity Application_Application Form_State Terr.xlsx		Yes	Yes	Fillable Fileable

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 56

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

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	56	56
Annual IC Time Burden (Hours)	168	168
Annual IC Cost Burden (Dollars)	8,229	8,229

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.