Information Collection Request

Senior Community Service Employment Program (SCSEP)

ICR 202108-1205-007 · OMB 1205-0040 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form ETA 9120 SPARQ Participant Form Form Removed Available
Form ETA 9120 SCSEP Participant Data Form Form Removed Repair queued
Form ETA 5140 SCSEP Quarterly Progress Report Form and Instruction New Available
Form ETA 9191 GPMS Data Collection Instrument Form and Instruction New Available
Form ETA 9120, ETA 9121 SPARQ Data Collection Forms Form and Instruction New Available
Form ETA 9120, ETA 9121 ETA 5140 and ETA 9191 Form and Instruction New Repair queued
Form ETA 8705B Equitable Distribution Report Form Modified Available
Form ETA 8705B Grantee Equitable Distribution Report Form Modified Repair queued
Form ETA 8705A Equitable Distribution Report Form Modified Available
Form ETA 8705A State Equitable Distribution Report Form Modified Repair queued
Form ETA 9182B Consent for Use and Publication of Information Form Removed Available
Form ETA 9182B SCSEP Consent for Use & Publication of Info Form Removed Repair queued
Form ETA 9182A Release and Authorization to Photograph Form Removed Available
Form ETA 9182A SCSEP Release and Authorization to Photograph Form Removed Repair queued
Form ETA 9181 Instructions for Discretionary Transfers Form Modified Available
Form ETA 9181 SCSEP Transfer Instructions Form Modified Missing upstream
Form ETA 9180B State of Sub-State Data Form Removed Available
Form ETA 9180B SCSEP Grantee Sub-State Data Form Removed Repair queued
Form ETA 9180A Goal Negotiation Calendar Form Removed Available
Form ETA 9180A SCSEP Negotiation Calendar Form Removed Repair queued
Form ETA 9123 SPARQ Exit Form Form Removed Available
Form ETA 9123 SCSEP Exit Form Form Removed Repair queued
Form ETA 9122 SCSEP Unsubsidized Employment Form Form Removed Repair queued
Form ETA 9122 SCSEP Unsubsidized Employment Form Form Removed Available
Form ETA 9121 SPARQ Community Service Form Form Removed Available
Form ETA 9121 SCSEP Community Service Assignment Form Form Removed Repair queued
Form ETA 8705 Equitable Distribution Report Form Removed Available
Form ETA 8705 SCSEP Equitable Distribution Report Form Removed Repair queued
Form ETA 9124A, 9124B, SCSEP Customer Satisfaction Surveys Form and Instruction Modified Available
Form ETA 9124A, 9124B, SCSEP Customer Satisfaction Surveys Form and Instruction Modified Missing upstream
Additional Context for ICR Changes 10.18.21.docx Supplementary Document Uploaded 2021-10-18 Repair queued
signed_PRA Signature Form_SCSEP_(2021_1001).pdf Supplementary Document Uploaded 2021-10-04 Missing upstream
1205-0040 Supporting Statement Part B Revised 100421.docx Supporting Statement B Uploaded 2021-10-04 Repair queued
1205-0040 Supporting Statement A 101221.docx Supporting Statement A Uploaded 2021-10-12 Missing upstream

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
43785 SCSEP Participant Data Form Form RemovedSPARQ Participant Form
43785 SCSEP Participant Data Form Form Removed
249068 ETA 5140 and ETA 9191 Form and Instruction NewSCSEP Quarterly Progress Report
249068 ETA 5140 and ETA 9191 Form and Instruction NewGPMS Data Collection Instrument
249068 ETA 5140 and ETA 9191 Form and Instruction NewSPARQ Data Collection Forms
249068 ETA 5140 and ETA 9191 Form and Instruction New
232731 Grantee Equitable Distribution Report Form ModifiedEquitable Distribution Report
232731 Grantee Equitable Distribution Report Form Modified
232730 State Equitable Distribution Report Form ModifiedEquitable Distribution Report
232730 State Equitable Distribution Report Form Modified
232728 SCSEP Consent for Use & Publication of Info Form RemovedConsent for Use and Publication of Information
232728 SCSEP Consent for Use & Publication of Info Form Removed
232727 SCSEP Release and Authorization to Photograph Form RemovedRelease and Authorization to Photograph
232727 SCSEP Release and Authorization to Photograph Form Removed
232726 SCSEP Transfer Instructions Form ModifiedInstructions for Discretionary Transfers
232726 SCSEP Transfer Instructions Form Modified
232725 SCSEP Grantee Sub-State Data Form RemovedState of Sub-State Data
232725 SCSEP Grantee Sub-State Data Form Removed
232724 SCSEP Negotiation Calendar Form RemovedGoal Negotiation Calendar
232724 SCSEP Negotiation Calendar Form Removed
215838 Planning Instructions and Allotments for SCSEP Instruction Modified
185407 SCSEP Four-Year State Strategy (and Two Year Modification) Modified
181011 SCSEP Exit Form Form RemovedSPARQ Exit Form
181011 SCSEP Exit Form Form Removed
181009 SCSEP Unsubsidized Employment Form Form RemovedSCSEP Unsubsidized Employment Form
181009 SCSEP Unsubsidized Employment Form Form Removed
181007 SCSEP Community Service Assignment Form Form RemovedSPARQ Community Service Form
181007 SCSEP Community Service Assignment Form Form Removed
180499 SCSEP Equitable Distribution Report Form RemovedEquitable Distribution Report
180499 SCSEP Equitable Distribution Report Form Removed
180160 SCSEP Customer Satisfaction Surveys Form and Instruction ModifiedSCSEP Customer Satisfaction Surveys
180160 SCSEP Customer Satisfaction Surveys Form and Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
11/30/2024 36 Months From Approved 11/30/2021
70,408 0 208,332
157,921 0 31,014
0 0 0





Reginfo record details
7
table that charts list of burden
IC Title Form No. Form Name
ETA 5140 and ETA 9191 ETA 9120, ETA 9121, ETA 9022, ETA 9123, ETA 9191, ETA 5140 ,   ,  
Grantee Equitable Distribution Report ETA 8705B
Planning Instructions and Allotments for SCSEP
SCSEP Community Service Assignment Form ETA 9121
SCSEP Consent for Use & Publication of Info ETA 9182B
SCSEP Customer Satisfaction Surveys ETA 9124A, 9124B, and 9124C
SCSEP Equitable Distribution Report ETA 8705
SCSEP Exit Form ETA 9123
SCSEP Four-Year State Strategy (and Two Year Modification)
SCSEP Grantee Sub-State Data ETA 9180B
SCSEP Negotiation Calendar ETA 9180A
SCSEP Participant Data Form ETA 9120
SCSEP Release and Authorization to Photograph ETA 9182A
SCSEP Transfer Instructions ETA 9181
SCSEP Unsubsidized Employment Form ETA 9122
State Equitable Distribution Report ETA 8705A

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 70,408 208,332 8,476 40,672 -187,072 0
Annual Time Burden (Hours) 157,921 31,014 25,427 124,746 -23,266 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No