Information Collection

CSBG Model Plan Application - States and Territories

IC 192928 under ICR 201005-0970-003 · OMB 0970-0382.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0382 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 CSBG Model Plan Application - States and Territories	Form
1 Application Outline for Model CSBG state Application.doc	Form
CSBG INFORMATION MEMORANDA - STATES.mht Imformation Memorandum	IC Document

IC Title:

CSBG Model Plan Application - States and Territories

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	Application	Outline for Model CSBG state Application.doc		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 56

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	56	56
Annual IC Time Burden (Hours)	560	560
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Imformation Memorandum	CSBG INFORMATION MEMORANDA - STATES.mht	05/06/2010

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