Information Collection

Financial Condition Monitoring Report

IC 213045 under ICR 202502-1559-002 · OMB 1559-0044.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 5 Financial Condition Monitoring Report	Form and Instruction
Form 5 Financial Condition Monitoring Report Financial Condition Monitoring Report	Form and Instruction
5 Financial Condition Monitoring Report FCM Report Template (updated 02-19-25).xlsx www.cdfifund.gov/programs-training/Programs/cdfi-bond/Pages/compliance-step.aspx#step5	Form and Instruction
5 Financial Condition Monitoring Report FCM Report Template (updated 02-19-25).xlsx www.cdfifund.gov/programs-training/Programs/cdfi-bond/Pages/compliance-step.aspx#step5	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 18 CFR 1808

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	5			https://www.cdfifund.gov/programs-training/Programs/cdfi-bond/Pages/compliance-step.aspx#step5	Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 40

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	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	160	0	160
Annual IC Time Burden (Hours)	280	13	267
Annual IC Cost Burden (Dollars)	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.

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