Senior Community Service Employment Program (SCSEP)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form ETA 9120 SPARQ Participant Form	Form	Modified	Available
Form ETA 8705B Equitable Distribution Report	Form	New	Available
Form ETA 8705A Equitable Distribution Report	Form	New	Available
Form ETA 9182B Consent for Use and Publication of Information	Form	New	Available
Form ETA 9182A Release and Authorization to Photograph	Form	New	Available
Form ETA 9181 Instructions for Discretionary Transfers	Form	New	Available
Form ETA 9180B State of Sub-State Data	Form	New	Available
Form ETA 9180A Goal Negotiation Calendar	Form	New	Repair queued
Form ETA-9123 SPARQ Exit Form	Form	Removed	Repair queued
Form ETA 9123 SPARQ Exit Form	Form	Modified	Available
Form ETA-9122 SCSEP Unsubsidized Employment Form	Form	Removed	Available
Form ETA 9122 SCSEP Unsubsidized Employment Form	Form	Modified	Repair queued
Form ETA 9121 SPARQ Community Service Assignment Form	Form	Removed	Available
Form ETA 9121 SPARQ Community Service Form	Form	Modified	Repair queued
Form ETA 9120 SPARQ Participant Form	Form	Removed	Available
Form ETA 8705 Equitable Distribution Report	Form	Modified	Available
Form ETA 9124A SCSEP Participant Survey Customer Satisfaction	Form and Instruction	Modified	Available
Form ETA 9124C Employer Customer Satisfaction Survey	Form and Instruction	Modified	Available
Form ETA 9124B Host Agency Customer Satisfaction Survey	Form and Instruction	Modified	Available
Attachment A_Summary of 60-Day FRN Comments and Responses.docx	Supplementary Document	Uploaded 2018-08-20	Available
1205-0040 Supporting Statement Part B_FINAL 8.7.18.docx	Supporting Statement B	Uploaded 2018-08-20	Repair queued
Part B review sign-off.pdf	Supplementary Document	Uploaded 2018-08-20	Repair queued
1205-0040 Supporting Statement Part A_FINAL 8.7.18.docx	Supporting Statement A	Uploaded 2018-08-20	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
43785	SCSEP Participant Data Form	Form	Modified	SPARQ Participant Form
232731	Grantee Equitable Distribution Report	Form	New	Equitable Distribution Report
232730	State Equitable Distribution Report	Form	New	Equitable Distribution Report
232728	SCSEP Consent for Use & Publication of Info	Form	New	Consent for Use and Publication of Information
232727	SCSEP Release and Authorization to Photograph	Form	New	Release and Authorization to Photograph
232726	SCSEP Transfer Instructions	Form	New	Instructions for Discretionary Transfers
232725	SCSEP Grantee Sub-State Data	Form	New	State of Sub-State Data
232724	SCSEP Negotiation Calendar	Form	New	Goal Negotiation Calendar
215838	Planning Instructions and Allotments for SCSEP	Instruction	Modified
185407	SCSEP Four-Year State Strategy	Instruction	Modified
181013	SCSEP Exit Form (National)	Form	Removed	SPARQ Exit Form
181011	SCSEP Exit Form	Form	Modified	SPARQ Exit Form
181010	SCSEP Unsubsidized Employment Form (National)	Form	Removed	SCSEP Unsubsidized Employment Form
181009	SCSEP Unsubsidized Employment Form	Form	Modified	SCSEP Unsubsidized Employment Form
181008	SCSEP Community Service Assignment Form (National)	Form	Removed	SPARQ Community Service Assignment Form
181007	SCSEP Community Service Assignment Form	Form	Modified	SPARQ Community Service Form
180574	SCSEP Participant Data Form (National)	Form	Removed	SPARQ Participant Form
180499	SCSEP Equitable Distribution Report	Form	Modified	Equitable Distribution Report
180160	SCSEP Employer and Host Agency Customer Satisfaction Surveys	Form and Instruction	Modified	SCSEP Participant Survey Customer Satisfaction
180160	SCSEP Employer and Host Agency Customer Satisfaction Surveys	Form and Instruction	Modified	Employer Customer Satisfaction Survey
180160	SCSEP Employer and Host Agency Customer Satisfaction Surveys	Form and Instruction	Modified	Host Agency Customer Satisfaction Survey

ICR Details

OMB Control No: 1205-0040	ICR Reference No: 201808-1205-001
Status: Historical Active	Previous ICR Reference No: 201603-1205-006
Agency/Subagency: DOL/ETA	Agency Tracking No:
Title: Senior Community Service Employment Program (SCSEP)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 11/08/2018
Retrieve Notice of Action (NOA)	Date Received in OIRA: 08/31/2018
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2021	36 Months From Approved	11/30/2018
Responses	208,332	0	232,520
Time Burden (Hours)	31,014	0	32,922
Cost Burden (Dollars)	0	0	0

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Abstract: The Senior Community Service Employment Program (SCSEP), is a community service and work-based training program for older workers. The program provides subsidized, work-experience training for low-income persons 55 or older who are unemployed and have poor employment prospects. SCSEP national grants are awarded through a competitive process; state and territorial grants are awarded through a formula outlined in the OAA-2016 Section 506 (b-c). The dual goals of the program are to promote useful community service employment activities and to move SCSEP participants into unsubsidized employment, so that they can achieve economic self-sufficiency. The Department is required to collect the information in order to comply with the OAA statutory and regulatory requirements. The information is also necessary for grantee performance accountability and program management.

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Authorizing Statute(s): PL: Pub.L. 114 - 144 500-518 Name of Law: Older Americans Act Reauthorization Act of 2016
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 12408	03/21/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 46193	08/31/2018
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 15

table that charts list of burden

IC Title	Form No.	Form Name
Grantee Equitable Distribution Report	ETA 8705B	Equitable Distribution Report
Planning Instructions and Allotments for SCSEP
SCSEP Community Service Assignment Form	ETA 9121	SPARQ Community Service Form
SCSEP Community Service Assignment Form (National)	ETA 9121	SPARQ Community Service Assignment Form
SCSEP Consent for Use & Publication of Info	ETA 9182B	Consent for Use and Publication of Information
SCSEP Employer and Host Agency Customer Satisfaction Surveys	ETA 9124C, ETA 9124B, ETA 9124A	Host Agency Customer Satisfaction Survey ,   Employer Customer Satisfaction Survey ,   SCSEP Participant Survey Customer Satisfaction
SCSEP Equitable Distribution Report	ETA 8705	Equitable Distribution Report
SCSEP Exit Form	ETA 9123	SPARQ Exit Form
SCSEP Exit Form (National)	ETA-9123	SPARQ Exit Form
SCSEP Four-Year State Strategy
SCSEP Grantee Sub-State Data	ETA 9180B	State of Sub-State Data
SCSEP Negotiation Calendar	ETA 9180A	Goal Negotiation Calendar
SCSEP Participant Data Form	ETA 9120	SPARQ Participant Form
SCSEP Participant Data Form (National)	ETA 9120	SPARQ Participant Form
SCSEP Release and Authorization to Photograph	ETA 9182A	Release and Authorization to Photograph
SCSEP Transfer Instructions	ETA 9181	Instructions for Discretionary Transfers
SCSEP Unsubsidized Employment Form	ETA 9122	SCSEP Unsubsidized Employment Form
SCSEP Unsubsidized Employment Form (National)	ETA-9122	SCSEP Unsubsidized Employment Form
State Equitable Distribution Report	ETA 8705A	Equitable Distribution Report

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	208,332	232,520	0	80,812	-105,000	0
Annual Time Burden (Hours)	31,014	32,922	0	11,992	-13,900	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Changing Regulations

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: As referenced in this information collection, ETA added the Annual Grant Planning and Allotment Requirements guidance TEGL, ETA 9181 (Discretionary Transfer Instructions for SCSEP), ETA 9182A (SCSEP Release and Authorization Photography), and ETA 9182B (SCSEP Consent for Use and Publication of Information) to this control number as a result of SCSEP’s financial, programmatic and reporting accountability. The following are the added burden under control number 1205-0040 (See Table 2 for more detail): • Planning Instructions and Allotments for SCSEP – number of respondents (76) multiplied by 1 (annually) multiplied by 16 hours equals 1216 annual burden hours; • SCSEP Negotiation Calendar Template (ETA Form 9180A) – number of respondents (15) multiplied by 1 (annually) multiplied by 5 minutes (.08) equals 1.20 annual burden hours; • SCSEP Grantee Sub-State Data Template (ETA-9180B) – number of respondents (15) multiplied by 1 (annually) multiplied by 3 hours equals 45 annual burden hours; • SCSEP Transfer Instructions (ETA-9181) – Total estimated annual responses (150) per number of respondents multiplied by 1 hour equals 150 annual burden hours; • SCSEP Release and Authorization to Photograph (ETA-9182A) – Total estimated annual responses (20) per number of respondents multiplied by 10 minutes (.17) equals 3.4 annual burden hours; and • SCSEP Consent for Use & Publication of Info (ETA-9181B) – Total estimated annual responses (20) per number of respondents multiplied by 10 minutes (.17) equals 3.4 annual burden hours. The federal cost burden increased in part due: • federal wage updates; program information collection for the Planning Instructions and Allotments for SCSEP; and program information collection for the ETA 9181 (Discretionary Transfer Instructions for SCSEP), ETA 9182A (SCSEP Release and Authorization Photography), and ETA 9182B (SCSEP Consent for Use and Publication of Information).

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Annual Cost to Federal Government: $83,069

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 08/31/2018

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