Information Collection

Semi-annual Progress Report for Culturally and Linguistically Specific Services Program

IC 191147 under ICR 201602-1122-002 · OMB 1122-0021.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1122-0021 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1122-0021 Semi-annual progress report for the The Grants to Enhance Culturally and Linguistically Specific Services for Victims of Domestic Violence, Dating Violence, Sexual Assault, and Stalking Semi-annual Progress Report for Culturally and Linguistically Specific Services Program	Form
1122-0021 Semi-annual progress report for the The Grants to Enhanc CLSSPFormGMSSample.pdf	Form
Culturallyspecificprogramstataute.doc Federal Statute	IC Document

IC Title:

Semi-annual Progress Report for Culturally and Linguistically Specific Services Program

Agency IC Tracking Number:

1122-0021

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	1122-0021			www.gms.gov	Yes	Yes	Fillable Fileable Signable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 50

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	100	100
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Federal Statute		10/28/2009

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

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