Community Services Block Grant (CSBG) Model State Plan Applications

Forms and Documents

Document Name	Status
Form 1 CSBG State Plan Application for States Form and Instruction	Modified
Form 1 CSBG Eligible Entity Master List Form and Instruction	Modified
Supporting Statement A - CSBG MSP 0970-0382 071024.docx Supporting Statement A	2024-07-10

IC Document Collections

IC ID	Document Title	Status
230742	CSBG State Plan Application for States Form and Instruction	Modified
230741	CSBG Eligible Entity Master List Form and Instruction	Modified
226996	CSBG ACSI Survey of Eligible Entities Other-Survey	Modified

ICR Details

OMB Control No: 0970-0382	ICR Reference No: 202407-0970-002
Status: Received in OIRA	Previous ICR Reference No: 202302-0970-006
Agency/Subagency: HHS/ACF	Agency Tracking No: OCS
Title: Community Services Block Grant (CSBG) Model State Plan Applications
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 07/12/2024

	Requested	Previously Approved
Expiration Date	36 Months From Approved	08/31/2024
Responses	779	448
Time Burden (Hours)	1,724	1,959
Cost Burden (Dollars)	0	0

---

Abstract: Community Service Block Grant (CSBG) grant recipients (CSBG state and territory lead agencies) develop and submit the data in the CSBG State Plan to the OCS, Division of Community Assistance (DCA). DCA reviews the CSBG State Plans to determine whether CSBG grant recipients submitted a complete application to qualify for federal funds in compliance with the CSBG Act. OCS administers the ACSI biennially to CSBG sub-grant recipients (CSBG-eligible entities) to seek feedback and better understand performance in several areas related to the CSBG grant recipients administration of CSBG. The results of this survey provide data to the CSBG lead agency that can be used in developing future CSBG State Plans and in guiding improved performance efforts. The next time OCS will administer this survey is 2025 and participation in the survey is voluntary. The automated CSBG State Plan streamlines both the state development and the federal review of the information. In addition, with the automated plan, state and federal staff will interact with and use the data to improve performance and track results from year-to-year. This data collection also includes the collection of the CSBG Eligible Entity Master List. The CSBG Eligible Entity Master List interacts with the CSBG State Plan to ensure that eligible entities are correctly identified across all forms and systems. There are no proposed revisions to the CSBG State Plan, CSBG Eligible Entity List, or ACSI. Burden estimates have been updated to reflect current estimates for number of respondents and the State Plan has minor edits for 508-compliance purposes.

---

Authorizing Statute(s): US Code: 42 USC 9908 Name of Law: Community Service Block Grant (CSBG) Act
  

Citations for New Statutory Requirements: None

---

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

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 31207	04/24/2024
30-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 57154	07/12/2024
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 3

IC Title	Form No.	Form Name
CSBG ACSI Survey of Eligible Entities
CSBG Eligible Entity Master List	1	CSBG Eligible Entity List 2.1
CSBG State Plan Application for States	1	CSBG State Plan 3.0

---

ICR Summary of Burden

	Total Request	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	779	448	0	331	0	0
Annual Time Burden (Hours)	1,724	1,959	0	-235	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

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

Burden Reduction Due to: Miscellaneous Actions

Short Statement: There are no changes to the information requested. Burden estimates have been updated to reflect current estimates for number of respondents and minor edits were made to the State Plan for 508-compliance purposes.

---

Annual Cost to Federal Government: $6,938

Does this IC contain surveys, censuses, or employ statistical methods? No

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

---

Common Form ICR:  No

---

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: 07/12/2024

---