Senior Community Service Employment Program (SCSEP)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form ETA 9191 GPMS Data Collection Instrument	Form and Instruction	New	Available
Form ETA 9124A Participant Survey	Form	Modified	Available
Form ETA 9124C2 Employer Survey	Form	Modified	Repair queued
Form ETA 9124C2 Employer Survey	Form	Removed	Repair queued
Form ETA 9124A Participant Survey	Form	Removed	Repair queued
Form ETA 9124B Host Agency Survey	Form	Modified	Repair queued
Form ETA 9124C1 Employer Survey	Form and Instruction	Unchanged	Repair queued
SCSEP CSS 1205-0040 Supporting Statement Part B_ clean.docx	Supporting Statement B	Uploaded 2024-03-13	Repair queued
signed_PRA Signature Form_SCSEP_(2024_0206).pdf	Supplementary Document	Uploaded 2024-03-13	Repair queued
Additional Context for ICR Changes 10.18.21.docx	Supplementary Document	Uploaded 2021-10-18	Repair queued
signed_PRA Signature Form_SCSEP_(2021_1001).pdf	Supplementary Document	Uploaded 2021-10-04	Repair queued
Supporting Statement A_1205-0040.docx	Supporting Statement A	Uploaded 2026-05-15	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
280456	ETA 9191 Combined	Form and Instruction	New	GPMS Data Collection Instrument
264386	Participant Customer Satisfaction – ETA-9124A	Form	Modified	Participant Survey
232730	Employer Customer Satisfaction – ETA-9124C2	Form	Modified	Employer Survey
232726	Non-Host Agency Employer Survey Pilot Project -- ETA-9124C2	Form	Removed	Employer Survey
215838	Participant Survey Pilot Project -- ETA-9124A	Form	Removed	Participant Survey
215838	Participant Survey Pilot Project -- ETA-9124A	Instruction	Removed
185407	Host Agency Customer Satisfaction – ETA-9124B	Form	Modified	Host Agency Survey
180160	Employer Customer Satisfaction – ETA-9124C1	Form and Instruction	Unchanged	Employer Survey

ICR Details

OMB Control No: 1205-0040	ICR Reference No: 202605-1205-001
Status: Active	Previous ICR Reference No: 202401-1205-001
Agency/Subagency: DOL/ETA	Agency Tracking No:
Title: Senior Community Service Employment Program (SCSEP)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 05/21/2026
Retrieve Notice of Action (NOA)	Date Received in OIRA: 05/19/2026
Terms of Clearance: OMB is approving this collection for one year. Afterwards, ETA should resubmit the full package for notice and comment, incorporating all new burden hours.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2027	36 Months From Approved	07/31/2027
Responses	49,823	0	18,832
Time Burden (Hours)	21,246	0	2,786
Cost Burden (Dollars)	0	0	0

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Abstract: The Senior Community Service Employment Program (SCSEP), is a community service and work-based training program for older workers. The program provides subsidized, work-experience training for low-income persons 55 or older who are unemployed and have poor employment prospects. SCSEP national grants are awarded through a competitive process; state and territorial grants are awarded through a formula outlined in the OAA-2016 Section 506 (b-c). The dual goals of the program are to promote useful community service employment activities and to move SCSEP participants into unsubsidized employment, so that they can achieve economic self-sufficiency. The Department is required to collect the information in order to comply with the OAA statutory and regulatory requirements. The information is also necessary for grantee performance accountability and program management.

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Authorizing Statute(s): PL: Pub.L. 114 - 144 500-518 Name of Law: Older Americans Act Reauthorization Act of 2016
  

Citations for New Statutory Requirements: PL: Pub.L. 116 - 131 401 Name of Law: Supporting Older Americans Act of 2020

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 51858	08/04/2023
30-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 27802	04/18/2024
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 5

table that charts list of burden

IC Title	Form No.	Form Name
ETA 9191 Combined	ETA 9191	GPMS Data Collection Instrument
Employer Customer Satisfaction – ETA-9124C1	ETA 9124C1	Employer Survey
Employer Customer Satisfaction – ETA-9124C2	ETA 9124C2	Employer Survey
Host Agency Customer Satisfaction – ETA-9124B	ETA 9124B	Host Agency Survey
Non-Host Agency Employer Survey Pilot Project -- ETA-9124C2	ETA 9124C2	Employer Survey
Participant Customer Satisfaction – ETA-9124A	ETA 9124A	Participant Survey
Participant Survey Pilot Project -- ETA-9124A	ETA 9124A	Participant Survey

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	49,823	18,832	0	30,991	0	0
Annual Time Burden (Hours)	21,246	2,786	0	18,460	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Changing Forms

Short Statement: As part of this renewal request, ETA has added back in the Data Collection Instrument (Form ETA-9191) which has increased the burden from the previous revision request. The burden for the Customer Satisfaction Surveys (Form ETA-9124 series) has decreased slightly due to 1) the removal of the pilot versions of the survey, and 2) a decrease in the number of respondents. SCSEP grantees are required by the OAA to pay the minimum wage within the state or locality where their authorized positions are awarded. The applicable minimum wage determines how many participants the grantees can enroll. Increasing minimum wages at the state and local level have resulted in fewer modified positions each year, which, in turn, means fewer host agencies and employers each year. As a result, the number of potential respondents for each of the surveys has declined.

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 05/19/2026

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