CSBG ACSI Survey of Eligible Entities

Community Services Block Grant (CSBG) Program Model Plan Applications

Documents and Forms

Document Name Document Type
Form 1 CSBG ACSI Survey of Eligible Entities Form and Instruction
Form 1 CSBG ACSI Survey of Eligible Entities Form and Instruction
1 ACSI Survey of Eligible Entities CSBG ACSI Eligible Entity Survey Instrument.docx Form and Instruction
1 ACSI Survey of Eligible Entities CSBG ACSI Eligible Entity Survey Instrument.docx Form and Instruction

Information Collection (IC) Details

IC Title:	CSBG ACSI Survey of Eligible Entities	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	ACSI Survey of Eligible Entities	CSBG ACSI Eligible Entity Survey Instrument.docx		Yes	Yes	Fillable Printable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,007	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	336	336
Annual IC Time Burden (Hours)	111	111
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.