Information Collection

Initial Supplemental Report – M&A version

IC 259136 under ICR 202402-1505-002 · OMB 1505-0275.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1505-0275 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Initial Supplemental Report – M&A version	Form and Instruction
Initial Supplemental Report – M&A version	Form and Instruction
ECIP ISR Template - BHC MA ECIP ISR Template - BHC MA.xlsx	Form and Instruction
ECIP ISR Template - BHC MA ECIP ISR Template - BHC MA.xlsx	Form and Instruction
ECIP ISR Template CU MA ECIP ISR Template - CU MA.xlsx	Form and Instruction
ECIP ISR Template CU MA ECIP ISR Template - CU MA.xlsx	Form and Instruction
ECIP ISR Instructions BHC_MA ECIP_ISR_Instructions_BHC_MA.pdf	Form and Instruction
ECIP ISR Instructions BHC_MA ECIP_ISR_Instructions_BHC_MA.pdf	Form and Instruction
ECIP ISR Instructions CU_MA ECIP_ISR_Instructions_CU_MA.pdf	Form and Instruction
ECIP ISR Instructions CU_MA ECIP_ISR_Instructions_CU_MA.pdf	Form and Instruction

IC Title:

Initial Supplemental Report â M&A version

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	N/A	ECIP ISR Template - BHC MA	ECIP ISR Template - BHC MA.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	N/A	ECIP ISR Template CU MA	ECIP ISR Template - CU MA.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	N/A	ECIP ISR Instructions BHC_MA	ECIP_ISR_Instructions_BHC_MA.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	N/A	ECIP ISR Instructions CU_MA	ECIP_ISR_Instructions_CU_MA.pdf	Yes	Yes	Fillable Fileable

Line of Business: Economic Development

Subfunction: Business and Industry Development

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	3	3
Annual IC Time Burden (Hours)	480	480
Annual IC Cost Burden (Dollars)	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.