SF-424 Short Organizational (Short) 4040-0003

Forms and Documents

Document	Type	Status	Availability
Form 4040-0003 HHS SF-424 Short Organizational Burden Estimate 4040-0003	Form	Unchanged	Repair queued
Supporting Statement 4040-0003_2025.docx	Supporting Statement A	Uploaded 2025-05-05	Repair queued

IC Document Collections

IC ID	Collection	Type	Status	Form
186777	HHS SF-424 Short Organizational Burden Estimate 4040-0003	Form	Unchanged

ICR Details

OMB Control No: 4040-0003	ICR Reference No: 202502-4040-001
Status: Received in OIRA	Previous ICR Reference No: 202111-4040-001
Agency/Subagency: EGOV	Agency Tracking No:
Title: SF-424 Short Organizational (Short) 4040-0003
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR:  Yes
Type of Review Request: Regular	Date Submitted to OIRA: 05/16/2025

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	936	0
Time Burden (Hours)	936	0
Cost Burden (Dollars)	0	0

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Abstract: The SF-424 Short Organizational (short) form supports the streamlined application requirements of smaller applicant organizations and reduces the administrative burden on this community.

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Authorizing Statute(s): US Code: 31 USC 6301-6308 Name of Law: The Federal Grant and Cooperative Agreement Act of 1977
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 92946	11/25/2024
30-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 20681	05/15/2025
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
HHS SF-424 Short Organizational Burden Estimate 4040-0003	4040-0003	Application for Federal Domestic Assistance - Short Organizational

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ICR Summary of Burden

	Total Request	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	936	0	0	0	0	936
Annual Time Burden (Hours)	936	0	0	0	0	936
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $36,504

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  Yes

OIRA authorizes any Agency to begin using a Common Form associated with this ICR automatically after 5 calendar days from the date the agency's RCF including the common form was received in OIRA.

Description/Changes for Common Form Usage: 

Approved RCFs using this ICR

Agency/Sub Agency	RCF ID	RCF Title	RCF Status	IC Title

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 05/16/2025

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