Information Collection

Compliance Reporting and Recordkeeping

IC 241274 under ICR 202504-1505-003 · OMB 1505-0263.

Documents and Forms

Document Name Document Type
Q4 2021 Template - 4003 and 4112 Compliance Reporting and Recordkeeping Form
Q4 2021 Template - 4003 Only Compliance Reporting and Recordkeeping Form
Q4 2021 Template - 4112 Only Compliance Reporting and Recordkeeping Form
Quarterly Report Closeout Report Compliance Reporting and Recordkeeping Form
Baseline and Q3 Template Changes Screenshots 101420.docx Other-Screenshots
Baseline and Q3 Template Changes Screenshots 101420.docx Other-Screenshots
Q4 and Baseline 4112 Screenshots.pdf Other-Screenshots
Q4 and Baseline 4112 Screenshots.pdf Other-Screenshots
Q4 4003-only screenshots.pdf Other-Screenshots
Q4 4003-only screenshots.pdf Other-Screenshots
Q4 4112_4003 screenshots.pdf Other-screenshots
Q4 4112_4003 screenshots.pdf Other-screenshots
4003-4112 Combo Screenshots as of 05212021.pdf Other-Screenshots
4003-4112 Combo Screenshots as of 05212021.pdf Other-Screenshots
4112 Screenshots as of 05202021.pdf Other-Screenshots
4112 Screenshots as of 05202021.pdf Other-Screenshots
Q4 Baseline Screenshots as of 05192021.pdf Other-Screenshots
Q4 Baseline Screenshots as of 05192021.pdf Other-Screenshots
Q1 2021 4003 Only 05212021.pdf Other-Screenshots
Q1 2021 4003 Only 05212021.pdf Other-Screenshots
062921CARESActExecutiveCompInformationRequest_final.xlsx Other-Template
062921CARESActExecutiveCompInformationRequest_final.xlsx Other-Template
Additional Questions_PSP4003 Q3 2021_11.18.docx Other-additional question set
Additional Questions_PSP4003 Q3 2021_11.18.docx Other-additional question set
Q4 2021 Template - 4003 and 4112 40034112 Combo Q4 2021 Template Questions_v1.pdf Form
Q4 2021 Template - 4003 and 4112 40034112 Combo Q4 2021 Template Questions_v1.pdf Form
Q4 2021 Template - 4003 Only 4003 Only Q4 2021 Template Questions_v1.pdf Form
Q4 2021 Template - 4003 Only 4003 Only Q4 2021 Template Questions_v1.pdf Form
Q4 2021 Template - 4112 Only 4112 Only Q4 2021 Template Questions_v1.pdf Form
Q4 2021 Template - 4112 Only 4112 Only Q4 2021 Template Questions_v1.pdf Form
Quarterly Report Closeout Report 1505-0263 PSP Template Draft 2023-0906 v1.pdf Form
Quarterly Report Closeout Report 1505-0263 PSP Template Draft 2023-0906 v1.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Compliance Reporting and Recordkeeping	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:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Screenshots			Baseline and Q3 Template Changes Screenshots 101420.docx	Yes	Yes	Fillable Fileable
Other-Screenshots			Q4 and Baseline 4112 Screenshots.pdf	Yes	Yes	Fillable Fileable
Other-Screenshots			Q4 4003-only screenshots.pdf	Yes	Yes	Fillable Fileable
Other-screenshots			Q4 4112_4003 screenshots.pdf	Yes	Yes	Fillable Fileable
Other-Screenshots			4003-4112 Combo Screenshots as of 05212021.pdf	Yes	Yes	Fillable Fileable
Other-Screenshots			4112 Screenshots as of 05202021.pdf	Yes	Yes	Fillable Fileable
Other-Screenshots			Q4 Baseline Screenshots as of 05192021.pdf	Yes	Yes	Fillable Fileable
Other-Screenshots			Q1 2021 4003 Only 05212021.pdf	Yes	Yes	Fillable Fileable
Other-Template			062921CARESActExecutiveCompInformationRequest_final.xlsx	Yes	Yes	Fillable Fileable
Other-additional question set			Additional Questions_PSP4003 Q3 2021_11.18.docx	Yes	Yes	Fillable Fileable
Form	NA	Q4 2021 Template - 4003 and 4112	40034112 Combo Q4 2021 Template Questions_v1.pdf	Yes	Yes	Fillable Fileable
Form	NA	Q4 2021 Template - 4003 Only	4003 Only Q4 2021 Template Questions_v1.pdf	Yes	Yes	Fillable Fileable
Form	NA	Q4 2021 Template - 4112 Only	4112 Only Q4 2021 Template Questions_v1.pdf	Yes	Yes	Fillable Fileable
Form	N/A	Quarterly Report Closeout Report	1505-0263 PSP Template Draft 2023-0906 v1.pdf	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Economic Development

Subfunction: Industry Sector Income Stabilization

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 34	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	136	-2,664	2,800
Annual IC Time Burden (Hours)	578	-11,322	11,900
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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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