Information Collection

Commuunity-Based Child Abuse Prevention Program-Application

IC 185462 under ICR 202411-0970-011 · OMB 0970-0155.

Documents and Forms

Document Name Document Type
CBCAP Application_General Template_final.docx Instruction
CBCAP Application_General Template_final.docx Instruction
PI Attachment 1_CBCAP CONCEPTUAL FRAMEWORK.docx Attachment 1: CBCAP Conceptual Framework IC Document
PI Attachment 1_CBCAP CONCEPTUAL FRAMEWORK.docx Attachment 1: CBCAP Conceptual Framework IC Document
PI Attachment 2_Tentative Population Allocation of CBCAP Funds.docx Attachment 2: Tentative Population Allocation of CBCAP Funds IC Document
PI Attachment 2_Tentative Population Allocation of CBCAP Funds.docx Attachment 2: Tentative Population Allocation of CBCAP Funds IC Document
PI Attachment 3. Governors Assurance_with proposed changes_CLEAN.docx Attachment 3: Governor’s Assurance Statement IC Document
PI Attachment 3. Governors Assurance_with proposed changes_CLEAN.docx Attachment 3: Governor’s Assurance Statement IC Document
PI Attachment 4_State Lead Agency Assurance Statement.docx Attachment 4: State Lead Agency Assurance Statement IC Document
PI Attachment 4_State Lead Agency Assurance Statement.docx Attachment 4: State Lead Agency Assurance Statement IC Document
PI Attachment 5_Leveraged Funds Worksheet.docx Attachment 5: Leveraged Funds Worksheet with Example Worksheet and Guidance for Differentiation Between Leveraged and Match Fund IC Document
PI Attachment 5_Leveraged Funds Worksheet.docx Attachment 5: Leveraged Funds Worksheet with Example Worksheet and Guidance for Differentiation Between Leveraged and Match Fund IC Document
PI Attachment 7_Information and Resources to Promote Collaboration and Coordination.docx Attachment 7: Information and Resources to Promote Collaboration and Coordination with Other Child and Family Support Systems IC Document
PI Attachment 7_Information and Resources to Promote Collaboration and Coordination.docx Attachment 7: Information and Resources to Promote Collaboration and Coordination with Other Child and Family Support Systems IC Document
PI Attachment 8_Grants Management Contacts for CBCAP.docx Attachment 8: Grants Management Contacts for CBCAP IC Document
PI Attachment 8_Grants Management Contacts for CBCAP.docx Attachment 8: Grants Management Contacts for CBCAP IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Commuunity-Based Child Abuse Prevention Program-Application	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
Instruction			CBCAP Application_General Template_final.docx		Yes	Yes	Fillable Printable

Federal Enterprise Architecture Business Reference Module

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 52	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	52	52
Annual IC Time Burden (Hours)	2,080	2,080
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment 1: CBCAP Conceptual Framework	PI Attachment 1_CBCAP CONCEPTUAL FRAMEWORK.docx	11/19/2024
Attachment 2: Tentative Population Allocation of CBCAP Funds	PI Attachment 2_Tentative Population Allocation of CBCAP Funds.docx	11/19/2024
Attachment 3: Governorâs Assurance Statement	PI Attachment 3. Governors Assurance_with proposed changes_CLEAN.docx	11/19/2024
Attachment 4: State Lead Agency Assurance Statement	PI Attachment 4_State Lead Agency Assurance Statement.docx	11/19/2024
Attachment 5: Leveraged Funds Worksheet with Example Worksheet and Guidance for Differentiation Between Leveraged and Match Funds	PI Attachment 5_Leveraged Funds Worksheet.docx	11/19/2024
Attachment 7: Information and Resources to Promote Collaboration and Coordination with Other Child and Family Support Systems	PI Attachment 7_Information and Resources to Promote Collaboration and Coordination.docx	11/19/2024
Attachment 8: Grants Management Contacts for CBCAP	PI Attachment 8_Grants Management Contacts for CBCAP.docx	11/19/2024

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