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Pre-Expenditure Report Form
Social Services Block Grant (SSBG) Post-Expenditure Report, Pre-Expenditure and Intended Use Plan
OMB: 0970-0234
IC ID: 10079
OMB.report
HHS/ACF
OMB 0970-0234
ICR 202402-0970-004
IC 10079
( )
Documents and Forms
Document Name
Document Type
Form 1
Pre-Expenditure Report Form
Form
1 SSBG Pre-Expenditure Reporting Form
SSBG Pre-Expenditure Report.xlsx
Form
1 SSBG Pre-Expenditure Reporting Form
SSBG Pre-Expenditure Report.xlsx
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Pre-Expenditure Report Form
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Voluntary
CFR Citation:
42 CFR 1397c (To search for a specific CFR, visit the
Code of Federal Regulations.
)
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
1
SSBG Pre-Expenditure Reporting Form
SSBG Pre-Expenditure Report.xlsx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Community and Social Services
Subfunction:
Social Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
57
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
100 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
57
0
1
0
0
56
Annual IC Time Burden (Hours)
114
0
2
0
0
112
Annual IC Cost Burden (Dollars)
0
0
0
0
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.