Information Collection

Block Grant Application

IC 7545 under ICR 202505-0930-001 · OMB 0930-0168.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form BG Application Block Grant Application	Form and Instruction
Form BG Application BG Application Block Grant Application	Form and Instruction
Form SUBG Report SUBG Report Block Grant Application	Form and Instruction
Form MHGB Report MHBG Report Block Grant Application	Form and Instruction
BG Application BG Application FY2026-2027_BG Application_clean final revised version 4_23_25.docx	Form and Instruction
BG Application BG Application FY2026-2027_BG Application_clean final revised version 4_23_25.docx	Form and Instruction
SUBG Report SUBG Report FY2026-2027_SUBG_Report clean final 4_23_25.docx	Form and Instruction
SUBG Report SUBG Report FY2026-2027_SUBG_Report clean final 4_23_25.docx	Form and Instruction
MHGB Report MHBG Report FY2026-2027_MHBG Report_clean final revised version 4_23_25.docx	Form and Instruction
MHGB Report MHBG Report FY2026-2027_MHBG Report_clean final revised version 4_23_25.docx	Form and Instruction

IC Title:

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.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	BG Application	Yes	Yes	Fillable Fileable
Form and Instruction	SUBG Report	Yes	Yes	Fillable Fileable
Form and Instruction	MHGB Report	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	Previously Approved
Annual Number of Responses for this IC	119	119
Annual IC Time Burden (Hours)	33,493	33,493
Annual IC Cost Burden (Dollars)	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.

Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].