Information Collection

CSBG Model Plan Application - States and Territories

IC 192928 under ICR 201305-0970-011 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Form 1 CSBG Model Plan Application - States and Territories Form
1 application 8- 2010 OMB approved Outline for Model CSBG state Application (4) (2).docx Form
IM 127 Application for FY 2013 State and U_S_ Territories.mht IM IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	CSBG Model Plan Application - States and Territories	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	application	8- 2010 OMB approved Outline for Model CSBG state Application (4) (2).docx		Yes	Yes	Fillable Printable

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 %

	Approved	Previously Approved
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

Title	Document	Date Uploaded
IM	IM 127 Application for FY 2013 State and U_S_ Territories.mht	05/29/2013

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