Information Collection

Family Violence Prevention and Services: Grants to support Culturally Specific Domestic Violence and Sexual Assault (CSDVSA) Programs

IC 270280 under ICR 202602-0970-020 · OMB 0970-0490.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0490 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 CSDVSA PPR Family Violence Prevention and Services: Grants to support Culturally Specific Domestic Violence and Sexual Assault (CSDVSA) Programs	Form and Instruction
1 CSDVSA PPR CSDVSA_PPR Revised_12.5.2025_clean.docx	Form and Instruction
FVPSA 2024 OMB Clearance - FVPSA CSDVSA ACF Generic PPR 0970-0490_8.21.24.docx PPR GenIC - FVPS CSDVSA	IC Document
OFVPS CSDVSA PPR GenIC Change Request_12.9.25.docx Change Request - CSDVA PPR GenIC	IC Document

IC Title:

Family Violence Prevention and Services: Grants to support Culturally Specific Domestic Violence and Sexual Assault (CSDVSA) Programs

Agency IC Tracking Number:

OFVPS

IC Status: Unchanged

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	1				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: 35

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	70	70
Annual IC Time Burden (Hours)	700	700
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
PPR GenIC - FVPS CSDVSA		08/21/2024
Change Request - CSDVA PPR GenIC		12/09/2025

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

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