INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements.
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
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TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
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0565-NEW |
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| Federal Award Performance Monitoring and Reporting Form |
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| DATE PREPARED |
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| August 27, 2024 |
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| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
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ANNUAL BURDEN |
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REPORTS |
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RECORDS |
RESPONDENT COST |
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TOTAL BURDEN HOURS |
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TOTAL |
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FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
(Col. F x G) |
NO. OF |
ANNUAL |
RECORD- |
COST |
TOTAL |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
(H) |
RECORD- |
HOURS PER |
KEEPING HOURS |
PER |
COST |
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so state) |
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PER |
(Col. D x E) |
RESPONSE |
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KEEPERS |
RECORD- |
(Col. I x J) |
HOUR |
(Col. H x L) |
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RESPONDENT |
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EXEMPT |
NON-EXEMPT |
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KEEPER |
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| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
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(I) |
(J) |
(K) |
(L) |
(M) |
| 2 CFR 200.329 |
FPAC Federal Award Performance Monitoring and Reporting Form (Individuals or Households) |
None |
16 |
2 |
32 |
0.75 |
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24 |
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| 2 CFR 200.329 |
FPAC Federal Award Performance Monitoring and Reporting Form (Private sector) |
None |
2,014 |
2 |
4,028 |
0.75 |
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3,021 |
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| 2 CFR 200.329 |
FPAC Federal Award Performance Monitoring and Reporting Form (State, Local and Tribal Governments) |
None |
1,970 |
2 |
3,940 |
0.75 |
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2,955 |
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8,000 |
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6,000 |
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0.00 |
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TOTAL OF ALL PAGES |
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8,000 |
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6,000 |
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0.00 |
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0 |
| TOTAL - COLUMNS "F" AND "I" = OMB 83-I, 13b; COLUMNS "H" AND "K" = OMB 83-I, 13c |
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8,000 |
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6,000 |
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