NOA - CSBG Work Plan

NOTICE OF OFFICE OF MANAGEMENT AND BUDGET ACTION
Date

06/27/2023

Department of Health and Human Services
Administration for Children and Families
FOR CERTIFYING OFFICIAL:

Karl Mathias

FOR CLEARANCE OFFICER:

Sherrette Funn

In accordance with the Paperwork Reduction Act, OMB has taken action on your request received
06/14/2023
ACTION REQUESTED: Generic IC
Community Services Block Grant (CSBG) Work Plan Template
IC TITLE:
ICR REFERENCE NUMBER:

202306-0970-002

AGENCY ICR TRACKING NUMBER:
TITLE:

Generic for ACF Program Monitoring Activities

LIST OF INFORMATION COLLECTIONS: See next page
OMB ACTION: Approved without change
OMB CONTROL NUMBER:

0970-0558

The agency is required to display the OMB Control Number and inform respondents of its legal significance in
accordance with 5 CFR 1320.5(b).
EXPIRATION DATE: 11/30/2023

BURDEN:

DISCONTINUE DATE:

RESPONSES

HOURS

COSTS

Previous

4,500

45,000

2,184,300

New

4,500

45,000

2,184,300

Change due to New Statute

0

0

0

Change due to Agency Discretion

0

0

0

Change due to Agency Adjustment

0

0

0

Change due to PRA Violation

0

0

0

Difference

TERMS OF CLEARANCE:

Terms of the Generic ICR remain in effect.

OMB Authorizing Official:

Dominic J. Mancini
Deputy Administrator,
Office Of Information And Regulatory Affairs

IC Title
Office of Grants
Management Financial
Monitoring Review
Office of Head Start
Disaster Recovery
Improper Payment
Reviews
Office of Refugee
Resettlement Key
Personnel Minimum
Qualification Checklist
and Attestation
Office of Refugee
Resettlement Waiver
Request Form
Child Care and
Development Fund
(CCDF) State
Monitoring Compliance
Demonstration Packet
Office on Trafficking in
Persons (OTIP) Grant
Monitoring Tool (GMT)
Office of Refugee
Resettlement's Staff
Questionnaire Interpreter
Annual Data Collection
on Sexual Abuse and
Sexual Harassment
Involving
Unaccompanied
Children
Office of Refugee
Resettlement (ORR)
Refugee
Microenterprise
Development (MED)
Program Case File
Requirements
Office of Refugee
Resettlement Refugee
Career Pathways Case
File Requirements
Office of Refugee
Resettlement Refugee
Family Child Care
Microenterprise
Development File
Requirements
Office of Refugee
Resettlement (ORR)
Refugee Individual
Development Accounts
(IDA) Program Case
File Requirements
Office of Refugee
Resettlement (ORR)
Refugee Agricultural
Partnership Program
(RAPP) Case File
Requirements

Form No.

List of ICs
Form Name

CFR Citation

Hrs/$/Resp

1

Document Request List

380 / 0 / 95

1

Disaster Supplement
Payment Management
Reconciliation Example

80 / 0 / 80

360 / 0 / 2,115

141 / 0 / 470
850 / 0 / 17

1,050 / 0 / 105
M-11P

Staff Questionnaire Interpreter Questionnaire

58 / 0 / 115

M-16

Annual Data Collection on
Sexual Abuse and Sexual
Harassment Involving UC

450 / 0 / 300

600 / 0 / 30

840 / 0 / 42

150 / 0 / 15

620 / 0 / 31

500 / 0 / 25

IC Title

Form No.

List of ICs
Form Name

CFR Citation

Office of Refugee
Resettlement (ORR)
Ethnic Community SelfHelp (ECSH) Program
Case Documentation
Requirements
Low Income Household
Water Assistance
Program (LIHWAP)
Tribal Implementation
Check-In
Office of Head Start
Survey on Background
Checks and Staffing
Survivors of Torture
1
Survivors of Torture (SOT)
Integrated Care
Integrated Care
Continuum (SOT-ICC)
Continuum (ICC)
Low Income Household 1
LIHWAP Forecast
Water Assistance
Program (LIHWAP)
Grantee Forecast
Monitoring the Status of
Required Licensure
Office of Head Start
1
Payment Management
Improper Payment
Reconciliation Instrument
Reviews – Update 2023
Community Services
Block Grant (CSBG)
Work Plan Template
Total Hours Actually Used for Information Collections Under Currently Approved ICR:

Hrs/$/Resp
225 / 0 / 45

194 / 0 / 97

30 / 0 / 150
140 / 0 / 35
304 / 0 / 152

120 / 0 / 240
300 / 0 / 300
65 / 0 / 20
7,457