Form CB-496: Title IV-E Programs Quarterly Financial Report

Generic Clearance for Financial Reports used for ACF Non-Discretionary Grant Programs

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0510 can be found here:

Documents and Forms

Document Name Document Type
Form 496 Form CB-496: Title IV-E Programs Quarterly Financial Report Form
Form CB 496 INSTRUCTIONS - 02.26.20.docx Instruction
Form CB 496 INSTRUCTIONS - 02.26.20.docx Instruction
496 Form CB-496: Title IV-E Programs Quarterly Financial Rep Form CB-496 FORM - Final Proposed Revision 02.27.20 Clean.xlsx Form
496 Form CB-496: Title IV-E Programs Quarterly Financial Rep Form CB-496 FORM - Final Proposed Revision 02.27.20 Clean.xlsx Form
CB-496 Mandatory Grant Submission Template 2.27.20.docx NonDiscretionary Financial Form GenIC - Form CB-496 IC Document
CB-496 Mandatory Grant Submission Template 2.27.20.docx NonDiscretionary Financial Form GenIC - Form CB-496 IC Document

Information Collection (IC) Details

IC Title:	Form CB-496: Title IV-E Programs Quarterly Financial Report	Agency IC Tracking Number:	CB

IC Status: New

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	496	Form CB-496: Title IV-E Programs Quarterly Financial Report	Form CB-496 FORM - Final Proposed Revision 02.27.20 Clean.xlsx		Yes	Yes	Fillable Fileable
Instruction			Form CB 496 INSTRUCTIONS - 02.26.20.docx		Yes	Yes	Printable Only

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 67	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	268	268
Annual IC Time Burden (Hours)	6,700	6,700
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
NonDiscretionary Financial Form GenIC - Form CB-496	CB-496 Mandatory Grant Submission Template 2.27.20.docx	05/01/2024

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.