Financial Capability Form

ICR 201606-1122-001

OMB: 1122-0030

Federal Form Document

Forms and Documents
Document
Name
Status
Form
New
Supplementary Document
2016-06-20
Supplementary Document
2016-06-20
Supplementary Document
2016-06-20
Supplementary Document
2016-06-20
Supplementary Document
2016-06-20
Supporting Statement A
2016-06-21
IC Document Collections
IC ID
Document
Title
Status
222054 New
ICR Details
1122-0030 201606-1122-001
Historical Active
DOJ/OVW 1122-XXXX
Financial Capability Form
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 09/01/2016
Retrieve Notice of Action (NOA) 06/21/2016
  Inventory as of this Action Requested Previously Approved
09/30/2019 36 Months From Approved
40 0 0
160 0 0
0 0 0

In accordance with 2 CFR 200.205, the Office on Violence Against Women is seeking information required for assessing the financial risk of an applicant’s ability to administer federal funds. The form includes a mix of check box and narrative questions related to the organization’s financial systems, policies and procedures. The affected public includes non-governmental applicants to OVW grant programs that do not currently (or within the last 3 years) have funding from OVW.

US Code: 42 USC 13925, et seq. Name of Law: Violence Against Women Act
  
None

Not associated with rulemaking

  81 FR 6293 02/05/2016
81 FR 20673 04/08/2016
No

1
IC Title Form No. Form Name
Financial Capability Form 1122-XXXX Financial Capability Form

  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 40 0 0 40 0 0
Annual Time Burden (Hours) 160 0 0 160 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Changing Regulations
No
In accordance with 2 CFR 200.205, the Office on Violence Against Women is seeking information required for assessing the financial risk of an applicant’s ability to administer federal funds. The form includes a mix of check box and narrative questions related to the organization’s financial systems, policies and procedures. The affected public includes non-governmental applicants to OVW grant programs that do not currently (or within the last 3 years) have funding from OVW. A similar version of this form was approved by OMB for use by the Office of Justice Programs. Previously, OVW used that OJP form which has since been discontinued by OJP.

$2,240
No
No
No
No
No
Uncollected
Poston Catherine 202 514-5430 Catherine.Poston@usdoj.gov

  No

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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
06/21/2016


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