Information Collection

CSBG Annual Report: Grantees

IC 224194 under ICR 202001-0970-004 · OMB 0970-0492.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0492 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 CSBG Module 1 CSBG Annual Report: Grantees	Form and Instruction
Form 2 CSBG Module 2 CSBG Annual Report: Grantees	Form and Instruction
Form 3 CSBG Module 3 CSBG Annual Report: Grantees	Form and Instruction
Form 4 CSBG Module 4 CSBG Annual Report: Grantees	Form and Instruction
1 CSBG Module 1 CSBG Module 1 Revision Summary FY2019 _IOAS updates.docx	Form and Instruction
2 CSBG Module 2 RPT_CSBG_AR OMB CLEAR MOD2 FR1 Clean_FY2019.xlsm	Form and Instruction
3 CSBG Module 3 RPT_CSBG_AR OMB CLEAR MOD3 FR1 Clean_FY2019.xlsm	Form and Instruction
4 CSBG Module 4 RPT_CSBG_AR OMB CLEAR MOD4 FR1 Clean_FY2019.xlsx	Form and Instruction

IC Title:

CSBG Annual Report: Grantees

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:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Yes	Yes	Fillable Fileable
Form and Instruction	2	Yes	Yes	Fillable Fileable
Form and Instruction	3	Yes	Yes	Fillable Fileable
Form and Instruction	4	Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 52

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 52 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	52	0	0	52
Annual IC Time Burden (Hours)	10,296	0	-260	10,556
Annual IC Cost Burden (Dollars)	0	-269,706	0	269,706

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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

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