Community Services Block Grant (CSBG) Program Model Plan Applications

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 (2018-2021) CSBG State Plan - Through September 2021	Form and Instruction	Unchanged	Available
Form 1 CSBG State Plan (After September 2021)	Form and Instruction	Unchanged	Available
Form 1 CSBG State Plan Application for States	Form and Instruction	Unchanged	Repair queued
Form 1 CSBG Eligible Entity Master	Form and Instruction	Modified	Available
Form 1 CSBG Eligible Entity Master List	Form and Instruction	Modified	Repair queued
Form 1 ACSI Survey of Eligible Entities	Form and Instruction	Unchanged	Available
Form 1 CSBG ACSI Survey of Eligible Entities	Form and Instruction	Unchanged	Repair queued
NonSub Change Request Template_CSBG EE List_0970-0382_021523.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2023-02-22	Available
NonSub Change Request Template_CSBG EE List_0970-0382_021523.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2023-02-22	Repair queued
Supporting Statement - CSBG Model State Plan Application OMB 0970-0382_7.27.21 update_cln.docx	Supporting Statement A	Uploaded 2021-07-28	Available
Supporting Statement - CSBG Model State Plan Application OMB 0970-0382_7.27.21 update_cln.docx	Supporting Statement A	Uploaded 2021-07-28	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
230742	CSBG State Plan Application for States	Form and Instruction	Unchanged	CSBG State Plan - Through September 2021
230742	CSBG State Plan Application for States	Form and Instruction	Unchanged	CSBG State Plan (After September 2021)
230742	CSBG State Plan Application for States	Form and Instruction	Unchanged
230741	CSBG Eligible Entity Master List	Form and Instruction	Modified	CSBG Eligible Entity Master
230741	CSBG Eligible Entity Master List	Form and Instruction	Modified
226996	CSBG ACSI Survey of Eligible Entities	Form and Instruction	Unchanged	ACSI Survey of Eligible Entities
226996	CSBG ACSI Survey of Eligible Entities	Form and Instruction	Unchanged

ICR Details

OMB Control No: 0970-0382	ICR Reference No: 202302-0970-006
Status: Historical Active	Previous ICR Reference No: 202105-0970-018
Agency/Subagency: HHS/ACF	Agency Tracking No: OCS
Title: Community Services Block Grant (CSBG) Program Model Plan Applications
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 02/27/2023
Retrieve Notice of Action (NOA)	Date Received in OIRA: 02/23/2023
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2024	08/31/2024	08/31/2024
Responses	448	0	448
Time Burden (Hours)	1,959	0	1,959
Cost Burden (Dollars)	0	0	0

---

Abstract: CSBG grantees (states and territories) develop and submit the data in the CSBG State Plan to the OCS Division of Community Assistance (DCA). DCA reviews the CSBG State Plans to determine whether grantees have submitted a complete application to qualify for federal funds in compliance with the CSBG Act. OCS administers the ACSI biennially to CSBG subgrantees (eligible entities) to seek feedback and better understand performance in several areas related to the CSBG grantees administration of CSBG. The results of this survey provide data to the state that can be used in developing future CSBG State Plans and in guiding improvement efforts. The next time OCS will administer this survey is 2023 and participation in the survey is voluntary. This current request includes proposed revisions to the CSBG State Plan to further clarify the current questions; OCS added three additional questions to seek additional information based on congressional inquiries in the recent years – including how CSBG grantees distribute funds and policies that CSBG grantees have in place for monitoring CSBG subgrantees (known as CSBG eligible entities). The revised and automated CSBG State Plan streamlines both the state development and the federal review of the information. In addition, with the revised and automated plan, state and federal staff will interact with and use the data to improve performance and track results from year-to-year. This data collection also includes the collection of the CSBG Eligible Entity Master List. The CSBG Eligible Entity Master List interacts with the CSBG State Plan to ensure that eligible entities are correctly identified across all forms. Proposed revisions to the Master List include requesting information about the executive director and a website address (if applicable) for each agency listed. There are no proposed revisions to the ACSI.

---

Authorizing Statute(s): US Code: 42 USC 9908 Name of Law: Community Service Block Grant (CSBG) Act
  

Citations for New Statutory Requirements: None

---

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

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 22057	04/26/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 34018	06/28/2021
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 3

table that charts list of burden

IC Title	Form No.	Form Name
CSBG ACSI Survey of Eligible Entities	1	ACSI Survey of Eligible Entities
CSBG Eligible Entity Master List	1	CSBG Eligible Entity Master
CSBG State Plan Application for States	1, 1 (2018-2021)	CSBG State Plan (After September 2021) ,   CSBG State Plan - Through September 2021

---

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	448	448	0	0	0	0
Annual Time Burden (Hours)	1,959	1,959	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:

---

Annual Cost to Federal Government: $17,544

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.     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? No

---

Common Form ICR:  No

---

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: 02/23/2023

---