Information Collection

Intended Use Plan

IC 246254 under ICR 202102-0970-005 · OMB 0970-0234.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0234 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Intended Use Plan	Form
1 SSBG Post-Expenditure Reporting Form SSBG IUP Instructions_CC Final Draft.docx	Form
1 SSBG Post-Expenditure Reporting Form SSBG IUP Instructions_CC Final Draft.docx	Form
1 Intended Use Plan SSBG IUP Form V3.pdf	Form
1 Intended Use Plan SSBG IUP Form V3.pdf	Form

IC Title:

Intended Use Plan

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 45 CFR 96.74

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	1	SSBG Post-Expenditure Reporting Form	SSBG IUP Instructions_CC Final Draft.docx		Yes	Yes	Fillable Fileable
Form	1	Intended Use Plan	SSBG IUP Form V3.pdf		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: 56

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	56	56
Annual IC Time Burden (Hours)	2,240	2,240
Annual IC Cost Burden (Dollars)	0	0

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.