Information Collection

Block Grant Application

IC 7545 under ICR 202412-0930-002 · OMB 0930-0168.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0168 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form MHBG Block Grant Application	Form and Instruction
Form MHBG MHBG Block Grant Application	Form and Instruction
Form SUBG SUBG Block Grant Application	Form and Instruction
MHBG MHBG FY2026-2027_MHBG_Report.docx	Form and Instruction
MHBG MHBG FY2026-2027_MHBG_Report.docx	Form and Instruction
SUBG SUBG FY2026-2027_SUBG_Report.docx	Form and Instruction
SUBG SUBG FY2026-2027_SUBG_Report.docx	Form and Instruction

IC Title:

Block Grant 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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	MHBG				Yes	Yes	Fillable Fileable
Form and Instruction	SUBG				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: Block Grant

FR Citation: 75 FR 28264

Number of Respondents: 119

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	119	0	119
Annual IC Time Burden (Hours)	33,493	8,880	24,613
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.

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