Partnership Statement

IMLS Grant Program Application and Post-Award Report Forms

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3137-0071 can be found here:

Documents and Forms

Document Name Document Type
Form Application Form 4 Partnership Statement Form and Instruction
Application Form 4 Partnership Statement Partner.pdf www.imls.gov/applicants/forms/Partner.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Partnership Statement	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

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	Application Form 4	Partnership Statement	Partner.pdf	http://www.imls.gov/applicants/forms/Partner.pdf	Yes	Yes	Fillable Fileable

Line of Business: Education

Subfunction: Cultural and Historic Preservation

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 416	Number of Respondents for Small Entity: 100

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 99 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	416	416
Annual IC Time Burden (Hours)	71	71
Annual IC Cost Burden (Dollars)	1,860	1,860

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.