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View Information Collection (IC)

IC Title:	Annual Certification - Qualified Nonprofit Agency Serving People Who Are Severely Disabled	Agency IC Tracking Number:	404-02-27-2007

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 41 CFR 51-4.3

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	Committee Form 404	Annual Certification - Qualified Nonprofit Agency Serving People Who Are Severely Disabled	Accountability DRAFT 404 Form.doc	www.jwod.gov	Yes	No	Printable Only

Federal Enterprise Architecture Business Reference Module

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 565	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	565	0	0	0	0	565
Annual IC Time Burden (Hours)	12,430	0	10,735	0	0	1,695
Annual IC Cost Burden (Dollars)	621,500	0	621,500	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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