View Information Collection (IC)
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ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Forms and Regulatons for Grants to States for Construction and Acquisition of State Home Facilities
Agency IC Tracking Number:
2900-0661
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
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
10-0388-14
VA Checklist of Major Requirements for State Homes Construction/Acquisition Grants
Form 10-0388-14 VA Checklist.pdf
Yes
No
Fillable Printable
Form and Instruction
10-0388-1
Documents and Information Required for State Home Construction and Acquisition Grants - Initial Application
Form 10-0388-1.pdf
Yes
No
Fillable Printable
Form
10-0388-2
Certification of Compliance with Provisions of the Davis-Bacon Act
Form 10-0388-2 Davis-Bacon Act.pdf
Yes
No
Fillable Printable
Form
10-0388-3
State Home Construction Grant Program Space Program Analysis - Nursing Home & Domiciliary
Form 10-0388-3 Space Program Analysis-Nursing Home and Domiciliary (1).pdf
Yes
No
Fillable Printable
Form
10-0388-4
Sate Home Construction Grant Program Space Program Analysis - Adult Day Care
Form 10-0388-4 Space Program Analysis-Adult day Health Care (1).pdf
Yes
No
Fillable Printable
Form
10-0388-5
Additional Documents and Information Required for State Home Construction and Acquisition Grants Application
Form 10-0388-5.pdf
Yes
No
Fillable Printable
Form
10-0388-6
Certification of State Matching Funds To Qualify for Group 1 on the Priority List
Form 10-0388-6 State Matching Funds.pdf
Yes
No
Fillable Printable
Form and Instruction
10-0388-7
Certification Regarding Debarment, Suspension, and Other Responsibility Matters - Primary Covered Transactions
Form 10-0388-7 Certification Regarding Debarment, Suspension and Other Responsibilities.pdf
Yes
No
Fillable Printable
Form
10-0388-8
Certification Regarding Drug-Free Workplace Requirements for Grantees Other Than Individuals
Form 10-0388-8 Certification Re. Drug-Free Workplace.pdf
Yes
No
Fillable Printable
Form
10-0388-9
Certification Regarding Lobbying
Form 10-0388-9 Certification Re. Lobbying.pdf
Yes
No
Fillable Printable
Form
10-0388-10
Certification of Compliance With Federal Requirements - State Home Construction Grant
Form 10-0388-10 Certification of Compliance with Federal Requirements.pdf
Yes
No
Fillable Printable
Form and Instruction
10-0388-12
Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - Lower Tier Covered Transactions
Form 10-0388-12.pdf
Yes
No
Fillable Printable
Form
10-0388-13
Documents and Information Required for State Home Construction and Acquisition Grants - Post-Grant Requirements
Form 10-0388-13.pdf
Yes
No
Fillable Printable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Community and Social Services
Subfunction:
Community and Regional Development
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
50
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
0 %
Approved
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
50
0
0
0
50
0
Annual IC Time Burden (Hours)
1,200
0
0
0
1,200
0
Annual IC Cost Burden (Dollars)
0
0
0
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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