CSBG Eligible Entity Master List

Community Services Block Grant (CSBG) Program Model Plan Applications

Documents and Forms

Document Name Document Type
Form 1 CSBG Eligible Entity Master List Form and Instruction
Form 1 CSBG Eligible Entity Master List Form and Instruction
1 CSBG Eligible Entity Master TAB G CSBG Eligible Entity List 2.1 CLEAN.docx Form and Instruction
1 CSBG Eligible Entity Master TAB G CSBG Eligible Entity List 2.1 CLEAN.docx Form and Instruction
NonSub Change Request Template_CSBG EE List_0970-0382_021523.docx NonSub Change Memo IC Document
NonSub Change Request Template_CSBG EE List_0970-0382_021523.docx NonSub Change Memo IC Document

Information Collection (IC) Details

IC Title:	CSBG Eligible Entity Master List	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	CSBG Eligible Entity Master	TAB G CSBG Eligible Entity List 2.1 CLEAN.docx		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: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	56	56
Annual IC Time Burden (Hours)	112	112
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
NonSub Change Memo	NonSub Change Request Template_CSBG EE List_0970-0382_021523.docx	02/22/2023

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.