CHIPS Pre-Application Information Collection

Documents and Forms

Document Name Document Type
Financial Model White Paper vF. 8.4.23 docx.docx Other-Financial Model White Paper
Financial Model White Paper vF. 8.4.23 docx.docx Other-Financial Model White Paper
Pre-App Screenshots 9-21-23.pdf Other-Pre-App Screen Shots
Pre-App Screenshots 9-21-23.pdf Other-Pre-App Screen Shots
Simple Financial Model_v24 8.4.23.xlsx Other-Simple Financial Model
Simple Financial Model_v24 8.4.23.xlsx Other-Simple Financial Model
Offline Template - Sources & Uses vUpdated 8.4.23.xlsx Other-Pre-Application Sources and Us
Offline Template - Sources & Uses vUpdated 8.4.23.xlsx Other-Pre-Application Sources and Us
20230918 Pre-app Instruction Guide_Amendment-updated-v2.pdf Other-Pre-Application Instructions G
20230918 Pre-app Instruction Guide_Amendment-updated-v2.pdf Other-Pre-Application Instructions G
Published FRN CHIPS Pre Application.pdf Published FRN IC Document
Published FRN CHIPS Pre Application.pdf Published FRN IC Document
CHIPS Pre Application Supporting Statement A CLEAN.docx Supporting Statement A IC Document
CHIPS Pre Application Supporting Statement A CLEAN.docx Supporting Statement A IC Document
Supporting Statement B for pre application 3_23_23.docx Supporting Statement B IC Document
Supporting Statement B for pre application 3_23_23.docx Supporting Statement B IC Document
CHIPS Pre-Application Emergency Justification.pdf Emergency Justification IC Document
CHIPS Pre-Application Emergency Justification.pdf Emergency Justification IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	CHIPS Pre-Application Information Collection	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Financial Model White Paper	Financial Model White Paper vF. 8.4.23 docx.docx	Yes	Yes	Fillable Fileable
Other-Pre-App Screen Shots	Pre-App Screenshots 9-21-23.pdf	Yes	Yes	Fillable Fileable
Other-Simple Financial Model	Simple Financial Model_v24 8.4.23.xlsx	Yes	Yes	Fillable Printable
Other-Pre-Application Sources and Uses Offline Template	Offline Template - Sources & Uses vUpdated 8.4.23.xlsx	Yes	Yes	Fillable Printable
Other-Pre-Application Instructions Guide	20230918 Pre-app Instruction Guide_Amendment-updated-v2.pdf	Yes	Yes	Fillable Printable

Line of Business: Economic Development

Subfunction: Business and Industry Development

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 121	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	121	-19	140
Annual IC Time Burden (Hours)	7,260	-1,140	8,400
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Published FRN	Published FRN CHIPS Pre Application.pdf	03/03/2023
Supporting Statement A	CHIPS Pre Application Supporting Statement A CLEAN.docx	03/24/2023
Supporting Statement B	Supporting Statement B for pre application 3_23_23.docx	03/24/2023
Emergency Justification	CHIPS Pre-Application Emergency Justification.pdf	03/24/2023

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.