Self-Certification Eligibility Worksheet, Supplemental Planning and Demonstration Grants and Implementation Grants (300 Implementation Grants+ subset of 100 Supplemental Planning and Demonstration Gra

Safe Streets and Roads for All Grant Program

Documents and Forms

Document Name Document Type
Form OST Self-Certification Eligibility Worksheet, Supplemental Planning and Demonstration Grants and Implementation Grants (300 Implementation Grants+ subset of 100 Supplemental Planning and Demonstration Gra Form and Instruction
OST Self-Certification Eligibility Worksheet Exhibit-E-SS4A-Self-Certification-Eligibility-Worksheet-FY23.pdf Form and Instruction
OST Self-Certification Eligibility Worksheet Exhibit-E-SS4A-Self-Certification-Eligibility-Worksheet-FY23.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Self-Certification Eligibility Worksheet, Supplemental Planning and Demonstration Grants and Implementation Grants (300 Implementation Grants+ subset of 100 Supplemental Planning and Demonstration Gra	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

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	OST	Self-Certification Eligibility Worksheet	Exhibit-E-SS4A-Self-Certification-Eligibility-Worksheet-FY23.pdf		Yes	Yes	Fillable Fileable

Line of Business: Transportation

Subfunction: Ground Transportation

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 400	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	400	400
Annual IC Time Burden (Hours)	200	200
Annual IC Cost Burden (Dollars)	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.