CSBG State Plan Application for States

Community Services Block Grant (CSBG) Program Model Plan Applications

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0382 can be found here:

Documents and Forms

Document Name Document Type
Form 1 CSBG State Plan Application for States Form and Instruction
1 PLAN CSBG State Plan CSBG State Plan Template 3.0 CLEAN 062821.docx Form and Instruction
1 CSBG State Plan (After September 2021) CSBG State Plan Template 3.0 CLEAN 062821.docx Form and Instruction
1 (2018-2021) CSBG State Plan - Through September 2021 PLAN_CSBG_State Plan 2.0 FR2_FY2018.docx Form and Instruction

Information Collection (IC) Details

IC Title:	CSBG State Plan Application for States	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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	CSBG State Plan (After September 2021)	CSBG State Plan Template 3.0 CLEAN 062821.docx		Yes	Yes	Fillable Printable
Form and Instruction	1 (2018-2021)	CSBG State Plan - Through September 2021	PLAN_CSBG_State Plan 2.0 FR2_FY2018.docx		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: 56	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	56	56
Annual IC Time Burden (Hours)	1,736	1,736
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.