Information Collection

SCSEP Community Service Assignment Form (National)

IC 181008 under ICR 201608-1205-001 · OMB 1205-0040.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1205-0040 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form ETA 9121 SCSEP Community Service Assignment Form (National)	Form
ETA 9121 Community Service Assignment Form ETA-9121_SPARQ CSA Form_FINAL 8.1.16.docx	Form
ETA-9121_SPARQ CSA Form_Track Changes.docx Community Service Assignment Form (track changes)	IC Document

IC Title:

SCSEP Community Service Assignment Form (National)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR Part 641 (To search for a specific CFR, visit the Code of Federal Regulations.)

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	ETA 9121	Community Service Assignment Form	ETA-9121_SPARQ CSA Form_FINAL 8.1.16.docx		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 36

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
	Requested	Previously Approved
Annual Number of Responses for this IC	51,000	51,000
Annual IC Time Burden (Hours)	5,100	5,100
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Community Service Assignment Form (track changes)	ETA-9121_SPARQ CSA Form_Track Changes.docx	08/04/2016

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