View RCF - OIRA Conclusion

Title: Standard Form 424, "Application for Federal Assistance"

Type of RCF: RCF New
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/05/2025
Retrieve Notice of Action (NOA)	Date Received in OIRA: 01/21/2025
Terms of Clearance:

Description of Agency Usage: This form is used by applicants as a required factsheet for applications submitted for Federal assistance. The form's OMB No. 4040-0004. This package OMB No is 0575-0180

Authorizing Statute(s): None

Annual Cost to Federal Government:
Agency Contact: Lisa Day 971 313-4750 lisa.day@usda.gov

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		65	65	0	Form	SF-424	Application for Federal Assistance

RCF Summary of Burden:

	Total Approved	Change Due to Agency Discretion
Annual Number of Responses	65	65
Annual Time Burden (Hours)	65	65
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: The agency is requesting to use the form which will result in a program change of 65 burden hours.