OMB
.report
Search
Annual Representations and Certification
Representations and Certifications
OMB: 3037-0013
IC ID: 217811
OMB.report
CPBSD
OMB 3037-0013
ICR 201505-3037-001
IC 217811
( )
Documents and Forms
Document Name
Document Type
Form Reps and Certs
Annual Representations and Certification
Form and Instruction
Reps and Certs Annual Reps and Certs
Annual Reps and Certs Form 7_27_15.doc
Form and Instruction
Supporting Statement annual reps and certs.docx
Supporting Document
IC Document
Public Comment.docx
Public Comments
IC Document
Reps Certs Fact Sheet.docx
Fact Sheets
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Annual Representations and Certification
Agency IC Tracking Number:
0013
Is this a Common Form?
Yes
IC Status:
New
Obligation to Respond:
Mandatory
CFR Citation:
41 CFR 51-4.3 (To search for a specific CFR, visit the
Code of Federal Regulations.
)
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
Reps and Certs
Annual Reps and Certs
Annual Reps and Certs Form 7_27_15.doc
Yes
No
Printable Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Community and Social Services
Subfunction:
Social Services
Privacy Act System of Records
Title:
Annual Representations and Certification
FR Citation:
80 FR 27930
Number of Respondents:
559
Number of Respondents for Small Entity:
559
Affected Public:
Private Sector
Private Sector:
Not-for-profit institutions
Percentage of Respondents Reporting Electronically:
100 %
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
559
0
559
0
0
0
Annual IC Time Burden (Hours)
4,472
0
4,472
0
0
0
Annual IC Cost Burden (Dollars)
178,880
0
178,880
0
0
0
Documents for IC
Title
Document
Date Uploaded
Supporting Document
Supporting Statement annual reps and certs.docx
08/10/2015
Public Comments
Public Comment.docx
08/10/2015
Fact Sheets
Reps Certs Fact Sheet.docx
08/10/2015
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.