Regulatory Collection Filing

Application for Federal Assistance

RCF 201710-0572-032CF · Host ICR 201608-4040-014 · OMB 4040-0004

RCF Summary

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	2017-10-27
Conclusion Date	2017-11-02
Agency Tracking No.	0572-0139
Related Links	OMB 4040-0004 · ICR 201608-4040-014 · Retrieve Notice of Action (NOA)

RCF Details

View RCF - OIRA Conclusion

Title: Application for Federal Assistance

Type of RCF: RCF New
OIRA Conclusion Action: Approved without change	Conclusion Date: 11/02/2017
Retrieve Notice of Action (NOA)	Date Received in OIRA: 10/27/2017
Terms of Clearance:

Description of Agency Usage: This is the application used by applicants when applying for grants under Household Water System Program, 0572-0139.

Authorizing Statute(s): None

Annual Cost to Federal Government:
Agency Contact: Rebecca Hunt 202 205-3660 [email protected]

Common Form Information Collections (IC) in this RCF:

IC Title	Status	Responses	Hours	Dollars	Document Type	Form No.	Form Name
HHS SF-424 Burden Collection		14	14	0	Form	SF-424	Application for Federal Assistance

RCF Summary of Burden:

	Total Approved	Change Due to Agency Discretion
Annual Number of Responses	14	14
Annual Time Burden (Hours)	14	14
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: Use of common form.