Information Collection

Initial Supplemental Report – M&A version

IC 259136 under ICR 202606-1505-001 · OMB 1505-0275.

Documents and Forms

Document Name Document Type
ECIP ISR Template - BHC MA Initial Supplemental Report – M&A version Form and Instruction
ECIP ISR Template CU MA Initial Supplemental Report – M&A version Form and Instruction
ECIP ISR Instructions BHC_MA Initial Supplemental Report – M&A version Form and Instruction
ECIP ISR Instructions CU_MA Initial Supplemental Report – M&A version Form and Instruction
ECIP ISR Template - BHC MA ECIP ISR Template - BHC MA.xlsx Form and Instruction
ECIP ISR Template CU MA ECIP ISR Template - CU MA.xlsx Form and Instruction
ECIP ISR Instructions BHC_MA ECIP_ISR_Instructions_BHC_MA.pdf Form and Instruction
ECIP ISR Instructions CU_MA ECIP_ISR_Instructions_CU_MA.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Initial Supplemental Report â M&A version	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
Form and Instruction	N/A	ECIP ISR Template - BHC MA	ECIP ISR Template - BHC MA.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	N/A	ECIP ISR Template CU MA	ECIP ISR Template - CU MA.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	N/A	ECIP ISR Instructions BHC_MA	ECIP_ISR_Instructions_BHC_MA.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	N/A	ECIP ISR Instructions CU_MA	ECIP_ISR_Instructions_CU_MA.pdf	Yes	Yes	Fillable Fileable

Line of Business: Economic Development

Subfunction: Business and Industry Development

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 10	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 %

	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	10	7	3
Annual IC Time Burden (Hours)	1,600	1,120	480
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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