Information Collection

At Risk Receivership/Substandard/Troubled Program

IC 252313 under ICR 202601-2577-003 · OMB 2577-0301.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SF1199A Direct Deposit Sign Up Form At Risk Receivership/Substandard/Troubled Program	Form
Form SF 425 Federal Financial Report At Risk Receivership/Substandard/Troubled Program	Form
Form Form 53001 Actual Modernization Cost Certificate At Risk Receivership/Substandard/Troubled Program	Form
SF1199A Direct Deposit Sign Up Form SF1199A.pdf	Form
SF 425 Federal Financial Report SF425_3_0-V3.0 (1).pdf	Form
Form 53001 Actual Modernization Cost Certificate 53001.pdf	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SF1199A	Yes	Yes	Fillable Fileable
Form	SF 425	Yes	Yes	Fillable Fileable
Form	Form 53001	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: 15

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	30	-80	110
Annual IC Time Burden (Hours)	10	-670	680
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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