OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

State and Local Government

IC 271789 under ICR 202410-0584-001 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
04_D. Electronic Letter to States with Data Request.docx Other-04_D. Electronic Letter to Sta
04_D. Electronic Letter to States with Data Request.docx Other-04_D. Electronic Letter to Sta
05_E. Reminder Electronic Letter to States with Data Request.docx Other-05_E. Reminder Electronic Lett
05_E. Reminder Electronic Letter to States with Data Request.docx Other-05_E. Reminder Electronic Lett
06_F. State Administrative Cost Template.xlsx Other-06_F. State Administrative Cos
06_F. State Administrative Cost Template.xlsx Other-06_F. State Administrative Cos
07_G. Incentive Report Template.xlsx Other-07_G. Incentive Report Templat
07_G. Incentive Report Template.xlsx Other-07_G. Incentive Report Templat
08_H. Retailer list.xlsx Other-08_H. Retailer list
08_H. Retailer list.xlsx Other-08_H. Retailer list
09_I.Electronic Letter with Request to Schedule Interview - fns.docx Other-09_I.Electronic Letter with Re
09_I.Electronic Letter with Request to Schedule Interview - fns.docx Other-09_I.Electronic Letter with Re
10_J.Electronic Letter with Reminder to Schedule Interview.docx Other-10_J.Electronic Letter with Re
10_J.Electronic Letter with Reminder to Schedule Interview.docx Other-10_J.Electronic Letter with Re
11_K.Electronic Letter with Reminder about Interview.docx Other-11_K.Electronic Letter with Re
11_K.Electronic Letter with Reminder about Interview.docx Other-11_K.Electronic Letter with Re
12_L. In-Depth Interview Protocol.docx Other-12_L. In-Depth Interview Proto
12_L. In-Depth Interview Protocol.docx Other-12_L. In-Depth Interview Proto
14_N. Interview Consent Form.docx Other-14_N. Interview Consent Form
14_N. Interview Consent Form.docx Other-14_N. Interview Consent Form
15_O. Interview Follow Up and Thank You Note.docx Other-15_O. Interview Follow Up and
15_O. Interview Follow Up and Thank You Note.docx Other-15_O. Interview Follow Up and
23_V. Pretest Protocol.docx Other-23_V. Pretest Protocol
23_V. Pretest Protocol.docx Other-23_V. Pretest Protocol
13_M. Interview Worksheets.xlsx Other-13_M. Interview Worksheets
13_M. Interview Worksheets.xlsx Other-13_M. Interview Worksheets

Information Collection (IC) Details

View Information Collection (IC)

layout table

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
Other-04_D. Electronic Letter to States with Data Request 04_D. Electronic Letter to States with Data Request.docx Yes Yes Printable Only
Other-05_E. Reminder Electronic Letter to States with Data Request 05_E. Reminder Electronic Letter to States with Data Request.docx Yes Yes Printable Only
Other-06_F. State Administrative Cost Template 06_F. State Administrative Cost Template.xlsx Yes Yes Fillable Fileable
Other-07_G. Incentive Report Template 07_G. Incentive Report Template.xlsx Yes Yes Fillable Fileable
Other-08_H. Retailer list 08_H. Retailer list.xlsx Yes Yes Fillable Fileable
Other-09_I.Electronic Letter with Request to Schedule Interview - fns 09_I.Electronic Letter with Request to Schedule Interview - fns.docx Yes Yes Printable Only
Other-10_J.Electronic Letter with Reminder to Schedule Interview 10_J.Electronic Letter with Reminder to Schedule Interview.docx Yes Yes Printable Only
Other-11_K.Electronic Letter with Reminder about Interview 11_K.Electronic Letter with Reminder about Interview.docx Yes Yes Printable Only
Other-12_L. In-Depth Interview Protocol 12_L. In-Depth Interview Protocol.docx No   Paper Only
Other-14_N. Interview Consent Form 14_N. Interview Consent Form.docx Yes Yes Printable Only
Other-15_O. Interview Follow Up and Thank You Note 15_O. Interview Follow Up and Thank You Note.docx Yes Yes Printable Only
Other-23_V. Pretest Protocol 23_V. Pretest Protocol.docx Yes Yes Fillable Fileable
Other-13_M. Interview Worksheets 13_M. Interview Worksheets.xlsx Yes Yes Fillable Fileable

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 90 0 90 0 0 0
Annual IC Time Burden (Hours) 93 0 93 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 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.