View Information Collection Request (ICR) Package
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View Information Collection (IC) List
View Supporting Statement and Other Documents
Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
4040-0010
ICR Reference No:
201608-4040-012
Status:
Historical Active
Previous ICR Reference No:
201307-4040-008
Agency/Subagency:
EGOV
Agency Tracking No:
15380
Title:
SF-424 Project/Performance Site Location(s) Form; Key Contacts; Project Abstract
Type of Information Collection:
Extension without change of a currently approved collection
Common Form ICR:
Yes
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
12/01/2016
Retrieve Notice of Action (NOA)
Date Received in OIRA:
09/20/2016
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
12/31/2019
36 Months From Approved
11/30/2016
Responses
6,279
0
137,818
Time Burden (Hours)
6,279
0
68,909
Cost Burden (Dollars)
0
0
0
Abstract:
In compliance with section 3507(a)(1)(D) of the Paperwork Reduction Act of 1995, the Electronic Government Office (EGOV), Department of Health and Human Services, has submitted an Information Collection Request (ICR), described below, to the Office of Management and Budget (OMB) for review and approval. The ICR is for reinstatement of a previously-approved information collection assigned OMB control number 4040-0010, which expired on August 31, 2011. The ICR also requests categorizing the form as a common form, meaning HHS will only request approval for its own use of the form rather than aggregating the burden estimate across all Federal Agencies as was done for previous actions on this OMB control number.
Authorizing Statute(s):
PL:
Pub.L. 106 - 107 468
Name of Law: Federal Financial Assistance Management Improvement Act of 1999
PL:
Pub.L. 109 - 282 2590
Name of Law: Federal Funding Accountability and Transparency Act of 2006
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
81 FR 9487
02/25/2016
30-day Notice:
Federal Register Citation:
Citation Date:
81 FR 39933
06/20/2016
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
3
IC Title
Form No.
Form Name
Key Contacts
4040-0010
Key Contacts
Project Abstract
4040-0010
Project Abstract
Project Performance Site Location
4040-0010
Project/Performance Site Location
ICR Summary of Burden
Total Approved
Previously Approved
Change Due to New Statute
Change Due to Agency Discretion
Change Due to Adjustment in Estimate
Change Due to Potential Violation of the PRA
Annual Number of Responses
6,279
137,818
0
-131,539
0
0
Annual Time Burden (Hours)
6,279
68,909
0
-62,630
0
0
Annual Cost Burden (Dollars)
0
0
0
0
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:
Yes
Burden Reduction Due to:
Miscellaneous Actions
Short Statement:
The use of the Project Performance Site Location, Key Contacts Form, and the Project Abstract is at the discretion of the agency.
Annual Cost to Federal Government:
$244,881
Does this IC contain surveys, censuses, or employ statistical methods?
No
Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002?
No
Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]?
Yes
Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?
No
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
Yes
Is this ICR related to the Pandemic Response?
Uncollected
Agency Contact:
Ed Calimag 202 690-7569 Ed.Calimag@hhs.gov
Common Form ICR:
Yes
OIRA authorizes any Agency to begin using a Common Form associated with this ICR automatically after 5 calendar days from the date the agency's RCF including the common form was received in OIRA.
Description/Changes for Common Form Usage:
This form meets the definition of a Common Form as it is used by more than one Federal grant-making agency
Approved RCFs using this ICR
Agency/Sub Agency
RCF ID
RCF Title
RCF Status
IC Title
USDA/NIFA
201701-0524-066CF
Key Contracts and Project/Performance Site Locations(s)
Historical Active
Key Contacts, Project Performance Site Location
DOL/DM
201703-1225-013CF
SF-424 Project/Performance Site Location(s) Form; Key Contacts; Project Abstract --DOL Usage
Historical Active
Key Contacts, Project Abstract, Project Performance Site Location
TREAS/DO
201901-1505-002CF
Application, Reports, and Recordkeeping for the Social Impact Partnerships to Pay for Results Act (SIPPRA) grant program.
Historical Active
Project Performance Site Location
DOT/FMCSA
201901-2126-003CF
Key Contacts
Historical Active
Key Contacts
DOD/DODDEP
201802-0704-006CF
SF-424 Project/ Performance Site Location(s) Form; Key Contacts; Project Abstract
Historical Active
Project Performance Site Location
TREAS/DO
201811-1505-004CF
Social Impact Partnerships to Pay for Results Act (SIPPRA) grant program
Historical Active
Key Contacts, Project Abstract
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(a) It is necessary for the proper performance of agency functions;
(b) It avoids unnecessary duplication;
(c) It reduces burden on small entities;
(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;
(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;
(f) It indicates the retention periods for recordkeeping requirements;
(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.
(i) It uses effective and efficient statistical survey methodology (if applicable); and
(j) It makes appropriate use of information technology.
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Certification Date:
09/20/2016
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