Information Collection

Annual Certification - Qualified Nonprofit Agency Serving People Who Are Blind

IC 28977 under ICR 200904-3037-001 · OMB 3037-0001.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3037-0001 can be found here:

Documents and Forms

Document Name Document Type
Form 403 Annual Certification - Qualified Nonprofit Agency Serving People Who Are Blind Form
403-Instructions.docx Instruction
403 Annual Certification -Qualified Nonprofit Agency Serving 403 Form.doc Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Annual Certification - Qualified Nonprofit Agency Serving People Who Are Blind	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	403	Annual Certification -Qualified Nonprofit Agency Serving People Who Are Blind	403 Form.doc		Yes	No	Paper Only
Instruction			403-Instructions.docx		Yes	No	Paper Only

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 70	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	70	-7	77
Annual IC Time Burden (Hours)	420	189	231
Annual IC Cost Burden (Dollars)	12,600	12,600	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.