CMC Baseline Report Form

Connecting Minority Communities Pilot Program (CMC) Reporting Requirements

Documents and Forms

Document Name Document Type
Form TAB B CMC Baseline Report Form Form and Instruction
TAB B TAB B - CMC Baseline Report Connecting Minority Communities Pilot Program Report Forms (FINAL).xlsx Form and Instruction
TAB B TAB B - CMC Baseline Report FINAL Connecting Minority Communities Pilot Program Report Forms v2.xlsx Form and Instruction

Information Collection (IC) Details

IC Title:	CMC Baseline Report Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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 and Instruction	TAB B	TAB B - CMC Baseline Report	FINAL Connecting Minority Communities Pilot Program Report Forms v2.xlsx		Yes	Yes	Fillable Fileable

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 100	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	3,322	3,322
Annual IC Cost Burden (Dollars)	157,928	157,928

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.