CSBG Model Plan Application - Tribes and Tribal Governments

Community Services Block Grant (CSBG) Program Model Plan Applications

⚠️ Notice: This information collection may be referencing outdated material.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 - Tribes and Tribal Governments Form
1 application 8-2010 OMB approved Outline for Model CSBG Tribal Application (2) (4) (3).docx Form
IM 128 Application for FY 2013 Indian Tribes and Tribal Organizations.docx IM IC Document

Information Collection (IC) Details

IC Title:	CSBG Model Plan Application - Tribes and Tribal Governments	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 Tribal Application (2) (4) (3).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: 30	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	30	30
Annual IC Time Burden (Hours)	300	300
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
IM	IM 128 Application for FY 2013 Indian Tribes and Tribal Organizations.docx	05/29/2013

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