OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Community Services Block Grant (CSBG) Program Model Plan Applications

ICR 201803-0970-002 · OMB 0970-0382 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form 1 CSBG Model Plan Application Form and Instruction New Repair queued
Form 1 CSBG Eligible Entity Master List Form and Instruction New Repair queued
Form 1 ACSI CSBG Eligible Entity Survey Form and Instruction Modified Repair queued
Form 1 CSBG Model Plan Application - States and Territories Form Removed Repair queued
Supporting Statement OCS-0124 FY2019.docx Supporting Statement A Uploaded 2018-03-20 Available
IM 128 Application for FY 2013 Indian Tribes and Tribal Organizations.docx Supplementary Document Uploaded 2013-05-29 Available
IM 127 Application for FY 2013 State and U_S_ Territories.mht Supplementary Document Uploaded 2013-05-29 Source copy available
IC Document Collections
IC IDCollectionTypeStatusForm
230742 CSBG Model Plan Application Form and Instruction New
230741 CSBG Eligible Entity Master List Form and Instruction New
226996 ACSI CSBG Eligible Entity Survey Form and Instruction Modified
192928 CSBG Model Plan Application - States and Territories Form Removed
ICR Details
0970-0382 201803-0970-002
Historical Active 201705-0970-008
HHS/ACF OCS
Community Services Block Grant (CSBG) Program Model Plan Applications
Revision of a currently approved collection   No
Regular
Approved without change 06/29/2018
Retrieve Notice of Action (NOA) 03/20/2018
  Inventory as of this Action Requested Previously Approved
06/30/2021 36 Months From Approved 07/31/2018
1,131 0 1,091
1,983 0 2,366
0 0 0
The CSBG Model Plan Application will be used as the plan submitted to ACF by States, Territories, Tribes and Tribal Organizations for the receipt of Federal funds to administer a CSBG program. The information collected is required by the CSBG Statute for the receipt of CSBG program funds.
PL: Pub.L. 105 - 286 676 Name of Law: CSBG Program
  
None
Not associated with rulemaking
  82 FR 5438 11/17/2017
83 FR 11753 03/16/2018
Yes
  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 1,131 1,091 0 -16 56 0
Annual Time Burden (Hours) 1,983 2,366 0 -2,119 1,736 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
Yes
Miscellaneous Actions
Change due to adjustment..
$13,440
No
    No
    No
No
No
No
Uncollected
Robert Sargis 2026907275
  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.
03/20/2018