Community Services Block Grant (CSBG) Annual Report

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 4 CSBG Disaster Supplemental Annual Report Module 4	Form and Instruction	Modified	Available
Form 2 CSBG Disaster Supplemental Annual Report Module 2	Form and Instruction	Modified	Available
Form 1 CSBG Disaster Supplemental Annual Report Module 1	Form and Instruction	Modified	Available
Form 1 CSBG Disaster Annual Report: Sub-Grantees	Form and Instruction	Modified	Repair queued
Form 4 CSBG Disaster Supplemental Annual Report Module 4	Form and Instruction	Modified	Available
Form 2 CSBG Disaster Supplemental Annual Report Module 2	Form and Instruction	Modified	Available
Form 1 CSBG Disaster Supplemental Annual Report Module 1	Form and Instruction	Modified	Available
Form 1 CSBG Disaster Annual Report: Grantees	Form and Instruction	Modified	Repair queued
Form 4 CSBG CARES Supplemental Annual Report Module 4	Form and Instruction	Modified	Available
Form 2 CSBG CARES Supplemental Annual Report Module 2	Form and Instruction	Modified	Available
Form 1 CSBG CARES Supplemental Annual Report Module 1	Form and Instruction	Modified	Available
Form 1 CSBG CARES Annual Report: Sub-grantees	Form and Instruction	Modified	Repair queued
Form 4 CSBG CARES Supplemental Annual Report Module 4	Form and Instruction	Modified	Available
Form 2 CSBG CARES Supplemental Annual Report Module 2	Form and Instruction	Modified	Available
Form 1 CSBG CARES Supplemental Annual Report Module 1	Form and Instruction	Modified	Available
Form 1 CSBG CARES Annual Report: Grantees	Form and Instruction	Modified	Repair queued
Form 4 CSBG Module 4	Form and Instruction	Modified	Available
Form 3 CSBG Annual Report Module 3	Form and Instruction	Modified	Available
Form 2 CSBG Module 2	Form and Instruction	Modified	Available
Form 1 CSBG Module 1	Form and Instruction	Modified	Available
Form 1 CSBG Annual Report: Sub-Grantees	Form and Instruction	Modified	Repair queued
Form 4 CSBG Module 4	Form and Instruction	Modified	Available
Form 3 CSBG Annual Report Module 3	Form and Instruction	Modified	Available
Form 1 CSBG Module 1	Form and Instruction	Modified	Available
Form 1 CSBG Annual Report: Grantees	Form and Instruction	Modified	Repair queued
CSBG State Accountability Measures.pdf	Supplementary Document	Uploaded 2020-01-22	Repair queued
CSBG Federal Accountability Measures.pdf	Supplementary Document	Uploaded 2020-01-22	Repair queued
CSBG_AR OMB Supporting Statement.docx	Supporting Statement A	Uploaded 2021-04-15	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
244534	CSBG Disaster Annual Report: Sub-Grantees	Form and Instruction	Modified	CSBG Disaster Supplemental Annual Report Module 4
244534	CSBG Disaster Annual Report: Sub-Grantees	Form and Instruction	Modified	CSBG Disaster Supplemental Annual Report Module 2
244534	CSBG Disaster Annual Report: Sub-Grantees	Form and Instruction	Modified	CSBG Disaster Supplemental Annual Report Module 1
244534	CSBG Disaster Annual Report: Sub-Grantees	Form and Instruction	Modified
244533	CSBG Disaster Annual Report: Grantees	Form and Instruction	Modified	CSBG Disaster Supplemental Annual Report Module 4
244533	CSBG Disaster Annual Report: Grantees	Form and Instruction	Modified	CSBG Disaster Supplemental Annual Report Module 2
244533	CSBG Disaster Annual Report: Grantees	Form and Instruction	Modified	CSBG Disaster Supplemental Annual Report Module 1
244533	CSBG Disaster Annual Report: Grantees	Form and Instruction	Modified
244532	CSBG CARES Annual Report: Sub-grantees	Form and Instruction	Modified	CSBG CARES Supplemental Annual Report Module 4
244532	CSBG CARES Annual Report: Sub-grantees	Form and Instruction	Modified	CSBG CARES Supplemental Annual Report Module 2
244532	CSBG CARES Annual Report: Sub-grantees	Form and Instruction	Modified	CSBG CARES Supplemental Annual Report Module 1
244532	CSBG CARES Annual Report: Sub-grantees	Form and Instruction	Modified
244531	CSBG CARES Annual Report: Grantees	Form and Instruction	Modified	CSBG CARES Supplemental Annual Report Module 4
244531	CSBG CARES Annual Report: Grantees	Form and Instruction	Modified	CSBG CARES Supplemental Annual Report Module 2
244531	CSBG CARES Annual Report: Grantees	Form and Instruction	Modified	CSBG CARES Supplemental Annual Report Module 1
244531	CSBG CARES Annual Report: Grantees	Form and Instruction	Modified
224195	CSBG Annual Report: Sub-Grantees	Form and Instruction	Modified	CSBG Module 4
224195	CSBG Annual Report: Sub-Grantees	Form and Instruction	Modified	CSBG Annual Report Module 3
224195	CSBG Annual Report: Sub-Grantees	Form and Instruction	Modified	CSBG Module 2
224195	CSBG Annual Report: Sub-Grantees	Form and Instruction	Modified	CSBG Module 1
224195	CSBG Annual Report: Sub-Grantees	Form and Instruction	Modified
224194	CSBG Annual Report: Grantees	Form and Instruction	Modified	CSBG Module 4
224194	CSBG Annual Report: Grantees	Form and Instruction	Modified	CSBG Annual Report Module 3
224194	CSBG Annual Report: Grantees	Form and Instruction	Modified	CSBG Module 1
224194	CSBG Annual Report: Grantees	Form and Instruction	Modified

ICR Details

OMB Control No: 0970-0492	ICR Reference No: 202104-0970-009
Status: Historical Active	Previous ICR Reference No: 202012-0970-001
Agency/Subagency: HHS/ACF	Agency Tracking No: OCS
Title: Community Services Block Grant (CSBG) Annual Report
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 06/29/2021
Retrieve Notice of Action (NOA)	Date Received in OIRA: 04/26/2021
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2024	36 Months From Approved	06/30/2021
Responses	2,187	0	2,187
Time Burden (Hours)	1,241,795	0	1,241,795
Cost Burden (Dollars)	0	0	0

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Abstract: In November 2020, the Office of Community Services (OCS), Administration for Children and Families (ACF), U.S. Department of Health and Human Services (HHS), requested expedited review from the Office of Management and Budget (OMB) and simultaneously invited public comments on the proposed collection of data for new Community Services Block Grant (CSBG) CARES Supplemental and CSBG Disaster Supplemental funding Annual Reports. OCS proposed to collect this information through modified versions of the currently approved CSBG Annual Report. OMB approved the emergency request for 6-months. At this time, OCS is submitting a request to extend data collection, with minor revisions to materials based on public comments.

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Authorizing Statute(s): PL: Pub.L. 105 - 285 678E(a)(1)(A) and 678E(a)(2) Name of Law: CSBG Act
  

Citations for New Statutory Requirements: US Code: 42 USC 9902(2) Name of Law: Community Services Block Grant Program

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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:
	85 FR 73724	11/19/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 22056	04/26/2021
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 6

table that charts list of burden

IC Title	Form No.	Form Name
CSBG Annual Report: Grantees	4, 2, 1, 3	CSBG Module 1 ,   CSBG Annual Report Module 3 ,   CSBG Module 4
CSBG Annual Report: Sub-Grantees	1, 2, 3, 4	CSBG Module 1 ,   CSBG Module 2 ,   CSBG Annual Report Module 3 ,   CSBG Module 4
CSBG CARES Annual Report: Grantees	1, 2, 4	CSBG CARES Supplemental Annual Report Module 1 ,   CSBG CARES Supplemental Annual Report Module 2 ,   CSBG CARES Supplemental Annual Report Module 4
CSBG CARES Annual Report: Sub-grantees	4, 1, 2	CSBG CARES Supplemental Annual Report Module 1 ,   CSBG CARES Supplemental Annual Report Module 2 ,   CSBG CARES Supplemental Annual Report Module 4
CSBG Disaster Annual Report: Grantees	1, 2, 4	CSBG Disaster Supplemental Annual Report Module 1 ,   CSBG Disaster Supplemental Annual Report Module 2 ,   CSBG Disaster Supplemental Annual Report Module 4
CSBG Disaster Annual Report: Sub-Grantees	1, 2, 4	CSBG Disaster Supplemental Annual Report Module 1 ,   CSBG Disaster Supplemental Annual Report Module 2 ,   CSBG Disaster Supplemental Annual Report Module 4

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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	2,187	2,187	0	0	0	0
Annual Time Burden (Hours)	1,241,795	1,241,795	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $413,723

Does this IC contain surveys, censuses, or employ statistical methods? No

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.     No

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? Yes

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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: 04/26/2021

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