Information Collection

Pre-Expenditure Report Form

IC 10079 under ICR 202402-0970-004 · OMB 0970-0234.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0234 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Pre-Expenditure Report Form	Form
Form 1 SSBG Pre-Expenditure Reporting Form Pre-Expenditure Report Form	Form
1 SSBG Pre-Expenditure Reporting Form SSBG Pre-Expenditure Report.xlsx	Form
1 SSBG Pre-Expenditure Reporting Form SSBG Pre-Expenditure Report.xlsx	Form

IC Title:

Pre-Expenditure Report Form

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 42 CFR 1397c (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	SSBG Pre-Expenditure Reporting Form	SSBG Pre-Expenditure Report.xlsx		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: 57

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	57	1	56
Annual IC Time Burden (Hours)	114	2	112
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.