Regulatory Collection Filing

Application for Federal Assistance SF-424 - Discretionary

RCF 201607-0572-008CF · Host ICR 201608-4040-014 · OMB 4040-0004

RCF Summary

Request for correction metadata
Host OMB Control No.	4040-0004
Host ICR Reference No.	201608-4040-014
Agency/Subagency	USDA/RUS
Status	Historical Active
Type of RCF	RCF New
OIRA Conclusion Action	Approved without change
Date Received in OIRA	2017-01-03
Conclusion Date	2017-01-09
Agency Tracking No.	0572-0096
Related Links	OMB 4040-0004 · ICR 201608-4040-014 · Retrieve Notice of Action (NOA)

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Title: Application for Federal Assistance SF-424 - Discretionary

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Type of RCF: RCF New
OIRA Conclusion Action: Approved without change	Conclusion Date: 01/09/2017
Retrieve Notice of Action (NOA)	Date Received in OIRA: 01/03/2017
Terms of Clearance:

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Description of Agency Usage: Form is used to apply for assistance under this program. Distance Learning & Telemedicine Loan & Grant Program (0572-0096) applicants use this form to outline scope, costs and expenses for the project.

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Authorizing Statute(s): None

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Annual Cost to Federal Government:
Agency Contact: MaryPat Daskal 202-720-7853 [email protected]

Common Form Information Collections (IC) in this RCF:

table that charts list of ICs
IC Title	Status	Responses	Hours	Dollars	Document Type	Form No.	Form Name
HHS SF-424 Burden Collection		190	190	0	Form	SF-424	Application for Federal Assistance

RCF Summary of Burden:

table that charts list of burden
	Total Approved	Change Due to Agency Discretion
Annual Number of Responses	190	190
Annual Time Burden (Hours)	190	190
Annual Cost Burden (Dollars)	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

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

Burden Reduction Due to:

Short Statement: Common form usage.