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Federal forms, ICRs, and supporting documents

Information Collection Request

Application for the Senior Community Service Employment Program

ICR 200312-0596-003 · OMB 0596-0099 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC IDCollectionTypeStatusForm
3211 Application for the Senior Community Service Employment Program Form Migrated
ICR Details
0596-0099 200312-0596-003
Historical Active 200010-0596-001
USDA/FS
Application for the Senior Community Service Employment Program
Extension without change of a currently approved collection   No
Regular
Approved with change 03/04/2004
Retrieve Notice of Action (NOA) 12/22/2003
The agency is requested to revise its form consistent with DOL's new form and resubmit to OMB for approval.
  Inventory as of this Action Requested Previously Approved
10/31/2004 10/31/2004 03/31/2004
6,500 0 6,500
1,083 0 1,083
0 0 0
The data collected on the Application for the Senior Community Service Employment Program is for the economically disadvantaged person age 55 years or older. It is used to: (1) determine their eligibility for the program; (2) recertify their eligibility annually; and (3) prepare a quarterly progress report to the Department of Labor.
None
None
No
1
IC Title Form No. Form Name
Application for the Senior Community Service Employment Program FS-1800-21B
  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 6,500 6,500 0 0 0 0
Annual Time Burden (Hours) 1,083 1,083 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected
  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.
12/22/2003