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Federal forms, ICRs, and supporting documents

Information Collection Request

Government, Corporate or Foundation, and Individual Donor Form Application

ICR 201412-1405-002 · OMB 1405-0218 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form DS-4271 Government, Corporate or Foundation, and Individual Donor Form Applications Form and Instruction New Repair queued
Legal Authorities (10-2014).docx Supplementary Document Uploaded 2014-12-29 Repair queued
Supporting Statement (10-2014).docx Supporting Statement A Uploaded 2014-12-29 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
214454 Government, Corporate or Foundation, and Individual Donor Form Applications Form and Instruction New
ICR Details
1405-0218 201412-1405-002
Historical Active
STATE/AFA
Government, Corporate or Foundation, and Individual Donor Form Application
Existing collection in use without an OMB Control Number   No
Regular
Approved without change 12/29/2014
Retrieve Notice of Action (NOA) 12/29/2014
  Inventory as of this Action Requested Previously Approved
12/31/2017 36 Months From Approved
3,665 0 0
305 0 0
1,833 0 0
The Office of Emergencies in the Diplomatic and Consular Service (EDCS) manages the solicitation and acceptance of gifts to the U.S. Department of State. The information requested via donor letters is a necessary first step to accepting donations. The information is sought pursuant to 22 U.S.C. 2697, 5 U.S.C. 7324 and 22 CFR, Part 3) and will be used by EDCS's Gift Fund Coordinator to demonstrate the donor's intention to donate either an in-kind or monetary gift to the Department. This information is mandatory and must be completed before the gift is received by the Department.
US Code: 5 USC 7342 Name of Law: Foreign Gifts and Decorations Act
   US Code: 22 USC 2697 Name of Law: State Department Basic Authorities Act of 1956
  
None
Not associated with rulemaking
  79 FR 38353 07/07/2014
79 FR 63461 10/23/2014
No
1
IC Title Form No. Form Name
Government, Corporate or Foundation, and Individual Donor Form Applications DS-4271, DS-4272, DS-4273 Donor Form - Government ,   Donor Form - Corporate or Foundation ,   Donor Form - Individual
  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 3,665 0 0 0 0 3,665
Annual Time Burden (Hours) 305 0 0 0 0 305
Annual Cost Burden (Dollars) 1,833 0 0 0 0 1,833
No
No
$20,193
No
No
No
No
No
Uncollected
Frances Gidez 202 647-6286 [email protected]
  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.
12/29/2014