OMB
.report
Search
Department of State Mentor-Protege Program Application
Department of State Mentor-Protege Program Application
OMB: 1405-0161
IC ID: 38774
OMB.report
STATE/AFA
OMB 1405-0161
ICR 201405-1405-001
IC 38774
( )
Documents and Forms
Document Name
Document Type
Form DS-4053
Department of State Mentor-Protege Program Application
Form
DS-4053 Department of State Mentor Protégé Program Application
Collection Instrument-DS-4053 (7-2014).pdf
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Department of State Mentor-Protege Program Application
Agency IC Tracking Number:
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
DS-4053
Department of State Mentor Protégé Program Application
Collection Instrument-DS-4053 (7-2014).pdf
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Economic Development
Subfunction:
Business and Industry Development
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
20
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits
Percentage of Respondents Reporting Electronically:
98 %
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
20
0
0
6
0
14
Annual IC Time Burden (Hours)
240
0
0
-54
0
294
Annual IC Cost Burden (Dollars)
40
0
0
40
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.
