Information Collection

CSBG Model Plan Application - States and Territories

IC 192928 under ICR 201505-0970-004 · 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⚠️ Notice: This information collection may be referencing outdated material.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 and Instruction
1 CSBG State Plan Information Collection Instrument CSBG State Plan information collection instrument - attachment C.docx	Form and Instruction
CSBG State Plan Comments from 60-day notice - attachment B.xlsx CSBG State Plan Comments	IC Document
GDL_Accessing CSBG Model State Plan in OLDC.pdf GDL Accessing CSBG Model Plan in OLDC	IC Document
Section 676(b) of the CSBG Act - attachment A.docx Sec. 676(b) of the CSBG Act	IC Document
DRAFT CSBG State accountability measures - attachment D.docx DRAFT CSBG State Accountability Measures	IC Document

IC Title:

CSBG Model Plan Application - States and Territories

Agency IC Tracking Number:

ocs

Is this a Common Form? No

IC Status: Modified

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 and Instruction	1	CSBG State Plan Information Collection Instrument	CSBG State Plan information collection instrument - attachment C.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: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	56	0	56
Annual IC Time Burden (Hours)	1,848	1,288	560
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
CSBG State Plan Comments	CSBG State Plan Comments from 60-day notice - attachment B.xlsx	05/27/2015
GDL Accessing CSBG Model Plan in OLDC	GDL_Accessing CSBG Model State Plan in OLDC.pdf	05/27/2015
Sec. 676(b) of the CSBG Act	Section 676(b) of the CSBG Act - attachment A.docx	05/27/2015
DRAFT CSBG State Accountability Measures	DRAFT CSBG State accountability measures - attachment D.docx	05/27/2015

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