CSBG ARRA Expenditure Report

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
269 Supporting Statement FOR BACKUP SHEET.doc	Supporting Statement A	Uploaded 2009-07-22	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
190105	CSBG Backup Sheet for ARRA Expenditure Quaterly Report	Instruction	New

ICR Details

OMB Control No: 0970-0369	ICR Reference No: 200907-0970-006
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/ACF	Agency Tracking No:
Title: CSBG ARRA Expenditure Report
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 07/31/2009
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/21/2009
	Date Received in OIRA: 07/28/2009
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2010	6 Months From Approved
Responses	412	0	0
Time Burden (Hours)	1,648	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: This form is used to report ARRA expenditures. Section 678(B)(2) of the Community Service Block Grant (CSBG) Act reqiuires States receiving CSBG grants to make reports on program activities as required by the Secretary of Health and Human Services. 45 CFR 96.30 requires States to obligate and expend federal funds during a specific time period. SF 269A report form provides the mechanism for States to submit those reports under the CSBG program.

Emergency Justfication: The American Recovery and Reinvestment Act (ARRA) of 2009, establishes funds for the CSBG Program under PL 111-5. This legislation provides up to $1 billion to help States, Territories, and Tribes in fiscal years 2009 and 2010 for the reduction of poverty, the revitalization of low-income communities, and the empowerment of low-income families and individuals in rural and urban areas to become fully self-sufficient. Additionally, ARRA recipients are to report the spending and performance data to the Federal agency. A backup sheet has been created to identify the various activities that make up the total Federal share of outlays reported on the 269A Report line 10(a). This attachment to the 269A form ensures that all funds provided by the Recovery Act are clearly distinguishable in all agency financial systems, business systems and reporting systems. This request is being made under 5 CFR 1320.13 based on an unanticipated event. Approval is being requested by July 31, 2009. The American Recovery and Reinvestment Act (ARRA) of 2009, establishes funds for the CSBG Program under PL 111-5. This legislation provides up to $1 billion to help States, Territories, and Tribes in fiscal years 2009 and 2010 for the reduction of poverty, the revitalization of low-income communities, and the empowerment of low-income families and individuals in rural and urban areas to become fully self-sufficient. Additionally, ARRA recipients are to report the spending and performance data to the Federal agency. A backup sheet has been created to identify the various activities that make up the total Federal share of outlays reported on the 269A Report line 10(a). This attachment to the 269A form ensures that all funds provided by the Recovery Act are clearly distinguishable in all agency financial systems, business systems and reporting systems. This request is being made under 5 CFR 1320.13 based on an unanticipated event. Approval is being requested by July 31, 2009.

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Authorizing Statute(s): PL: Pub.L. 111 - 5 5001 Name of Law: ARRA
  

Citations for New Statutory Requirements: PL: Pub.L. 111 - 5 5001 Name of Law: ARRA

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 36715	07/24/2009
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
CSBG Backup Sheet for ARRA Expenditure Quaterly Report	1	Back Up Exenditure Report

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ICR Summary of Burden

table that charts list of burden

	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	412	0	412	0	0	0
Annual Time Burden (Hours)	1,648	0	1,648	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new ICR.

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Annual Cost to Federal Government: $20,000

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Yes

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 07/28/2009

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