Information Collection

Quarterly Supplemental Report Schedules A & B***

IC 259139 under ICR 202410-1505-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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
Quarterly Supplemental Report Schedules A & B***	Form and Instruction
QSR Instructions BHC Quarterly Supplemental Report Schedules A & B***	Form and Instruction
QSR Instructions CU Quarterly Supplemental Report Schedules A & B***	Form and Instruction
QSR Template BHC Quarterly Supplemental Report Schedules A & B***	Form and Instruction
QSR Template CU Quarterly Supplemental Report Schedules A & B***	Form and Instruction
QSR Instructions BHC - 06.23.23.docx	Instruction
QSR Instructions BHC - 06.23.23.docx	Instruction
QSR Instructions BHC QSR Instructions BHC - 06.15.23.docx	Form and Instruction
QSR Instructions BHC QSR Instructions BHC - 06.15.23.docx	Form and Instruction
QSR Instructions CU QSR Instructions CU - 06.15.23.docx	Form and Instruction
QSR Instructions CU QSR Instructions CU 2024-10-25.pdf	Form and Instruction
QSR Template BHC ECIP-Quarterly-Supplemental-Report-Template-B_HC_06122023 v11 (2).xlsx	Form and Instruction
QSR Template BHC ECIP-Quarterly-Supplemental-Report-Template-B_HC_06122023 v11 (2).xlsx	Form and Instruction
QSR Template CU ECIP-Quarterly-Supplemental-Report-Template-CU_From_6142023 v11 (1).xlsx	Form and Instruction
QSR Template CU ECIP-Quarterly-Supplemental-Report-Template-CU_From_6142023 v11 (1).xlsx	Form and Instruction

IC Title:

Quarterly Supplemental Report Schedules A & B***

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	N/A	Yes	Yes	Fillable Fileable
Form and Instruction	N/A	Yes	Yes	Fillable Fileable
Form and Instruction	N/A	Yes	Yes	Fillable Fileable
Form and Instruction	N/A	Yes	Yes	Fillable Fileable
Instruction		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: 180

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	720	720
Annual IC Time Burden (Hours)	7,200	7,200
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.

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