Information Collection

Federal State Marketing Improvement Prog. (State, Local, Tribal Gov't.)

IC 45630 under ICR 201608-0581-001 · OMB 0581-0240.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0581-0240 can be found here:

Documents and Forms

Document Name Document Type
Form AMS-33 Federal State Marketing Improvement Prog. (State, Local, Tribal Gov't.) Form
Grant Terms and Conditions 8-17-16.pdf www.ams.usda.gov Instruction
AMS-34 AMS Conflict of Interest and Confidentiality Statement 8-17-16.pdf www.ams.usda.gov Instruction
FSMIP Application Components Screenshot.docx www.ams.usda.gov Instruction
AMS-33 Agreement Face Sheet AMS-33 Agreement Face Sheet 8-17-16.pdf Form
Grant Program Project Beneficiaries Questionnaire Project Beneficiaries Questionnaire 8-17-16.docx Form and Instruction
AMS Grant Programs Worksheet to Accompany the SF-270 Req AMS Worksheet to Accompany each SF-270 Request 8-17-16.xlsx www.ams.usda.gov Form
Final Performance Report FSMIP Final Report Template 8-18-16.docx www.ams.usda.gov Form and Instruction
Peer Reviewer Application & Qualifications Form FSMIP Peer reviewer application 8-18-16.xlsx www.ams.usda.gov Form
Individual Reviewer Scoresheet Individual Reviewer 8-18-16.xlsx www.ams.usda.gov Form
HUD Form 50153 Certification of Consistency with Promise Zone Goals and HUD Promise Zone Certification Form 50153.pdf Form
Consensus Scoresheet & Comments Consensus Scoresheet.xlsx www.ams.usda.gov Form
Registration with SAM.gov (screenshot) SAM.gov Screen Shot.pdf www.SAM.gov Form
FSMIP Interim Performance Report FSMIP Interim Report Template.docx www.ams.usda.gov Form
Grant Program Accounting System & Financial Capability Q Accounting System Financial Capability Questionnaire 8-17-16.docx www.ams.usda.gov Form
Match Verification Letter Match Verification Letter 8-17-16.docx www.ams.usda.gov Form
Request for Applications Request for Applications 8-17-16.pdf www.ams.usda.gov Form and Instruction
Request for Grant Amendment Example.pdf Request for Grant Amendment Example Letter IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Federal State Marketing Improvement Prog. (State, Local, Tribal Gov't.)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 7 CFR 3015

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	AMS-33	Agreement Face Sheet	AMS-33 Agreement Face Sheet 8-17-16.pdf		Yes	Yes	Fillable Printable
Form and Instruction	None	Grant Program Project Beneficiaries Questionnaire	Project Beneficiaries Questionnaire 8-17-16.docx		Yes	Yes	Fillable Fileable
Instruction			Grant Terms and Conditions 8-17-16.pdf	www.ams.usda.gov	Yes	Yes	Fillable Fileable
Form	None	AMS Grant Programs Worksheet to Accompany the SF-270 Request for Advance/Reimbursement	AMS Worksheet to Accompany each SF-270 Request 8-17-16.xlsx	www.ams.usda.gov	Yes	Yes	Fillable Fileable
Form and Instruction	None	Final Performance Report	FSMIP Final Report Template 8-18-16.docx	www.ams.usda.gov	Yes	Yes	Fillable Fileable
Form	None	Peer Reviewer Application & Qualifications Form	FSMIP Peer reviewer application 8-18-16.xlsx	www.ams.usda.gov	Yes	Yes	Fillable Fileable
Instruction			AMS-34 AMS Conflict of Interest and Confidentiality Statement 8-17-16.pdf	www.ams.usda.gov	Yes	Yes	Fillable Fileable
Form	None	Individual Reviewer Scoresheet	Individual Reviewer 8-18-16.xlsx	www.ams.usda.gov	Yes	Yes	Fillable Fileable
Form	HUD Form 50153	Certification of Consistency with Promise Zone Goals and Implementation	HUD Promise Zone Certification Form 50153.pdf		Yes	Yes	Fillable Fileable
Form	None	Consensus Scoresheet & Comments	Consensus Scoresheet.xlsx	www.ams.usda.gov	Yes	Yes	Fillable Fileable
Form	None	Registration with SAM.gov (screenshot)	SAM.gov Screen Shot.pdf	www.SAM.gov	Yes	Yes	Fillable Fileable
Instruction			FSMIP Application Components Screenshot.docx	www.ams.usda.gov	Yes	Yes	Fillable Fileable
Form	None	FSMIP Interim Performance Report	FSMIP Interim Report Template.docx	www.ams.usda.gov	Yes	Yes	Fillable Fileable
Form	None	Grant Program Accounting System & Financial Capability Questionnaire	Accounting System Financial Capability Questionnaire 8-17-16.docx	www.ams.usda.gov	Yes	Yes	Fillable Fileable
Form	None	Match Verification Letter	Match Verification Letter 8-17-16.docx	www.ams.usda.gov	Yes	Yes	Fillable Fileable
Form and Instruction	None	Request for Applications	Request for Applications 8-17-16.pdf	www.ams.usda.gov	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Economic Development

Subfunction: Business and Industry Development

Privacy Act System of Records
Title:	FR Citation:

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

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	994	562	432
Annual IC Time Burden (Hours)	2,416	-2,947	5,363
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Request for Grant Amendment Example Letter	Request for Grant Amendment Example.pdf	09/29/2016

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