Information Collection

At Risk Receivership/Substandard/Troubled Program

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

Documents and Forms

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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	At Risk Receivership/Substandard/Troubled Program	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SF1199A	Direct Deposit Sign Up Form	SF1199A.pdf	Yes	Yes	Fillable Fileable
Form	SF 425	Federal Financial Report	SF425_3_0-V3.0 (1).pdf	Yes	Yes	Fillable Fileable
Form	Form 53001	Actual Modernization Cost Certificate	53001.pdf	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 %

	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

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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