# Agency Information Collection Request; 60-Day Public Comment Request
**AGENCY:**
Office of the Secretary, HHS.
**ACTION:**
Notice.
**SUMMARY:**
In compliance with the requirement of the Paperwork Reduction Act of 1995, the Office of the Secretary (OS), Department of Health and Human Services, is publishing the following summary of a proposed collection for public comment.
**DATES:**
Comments on the ICR must be received on or before July 2, 2018.
**ADDRESSES:**
Submit your comments to *[email protected]* or by calling (202) 795-7714.
**FOR FURTHER INFORMATION CONTACT:**
When submitting comments or requesting information, please include the document identifier 4040-0003-60D and project title for reference to *[email protected],* or call the Reports Clearance Officer.
**SUPPLEMENTARY INFORMATION:**
Interested persons are invited to send comments regarding this burden estimate or any other aspect of this collection of information, including any of the following subjects: (1) The necessity and utility of the proposed information collection for the proper performance of the agency's functions; (2) the accuracy of the estimated burden; (3) ways to enhance the quality, utility, and clarity of the information to be collected; and (4) the use of automated collection techniques or other forms of information technology to minimize the information collection burden.
*Title of the Collection:* Application for Federal Domestic Assistance—Short Organizational.
*Type of Collection:* Extension.
*OMB No.:* 4040-0003.
*Abstract:* Application for Federal Domestic Assistance-Short Organizational is used by applicants to apply for Federal financial assistance. The Application for Federal Domestic Assistance-Short Organizational allows the applicants to provide organizational details as part of their grant proposals. This form is evaluated by Federal agencies as part of the overall grant application. *Grants.gov* seeks a 3-year extension.
*Type of Respondent:* The Application for Federal Domestic Assistance-Short Organizational form is used by organizations to apply for Federal financial assistance in the form of grants. These forms are submitted to the Federal grant-making agencies for evaluation and review.
| Forms | Respondents | Number of | Number of | Average | Total |
| --- | --- | --- | --- | --- | --- |
| Application for Federal Domestic Assistance-Short Organizational | Grant-seeking organizations | 936 | 1 | 1 | 936 |
| Total | | | 1 | | 936 |
Terry Clark,
Office of the Secretary, Asst. Paperwork Reduction Act Reports Clearance Officer.