Civil Rights Title VI

Forms and Documents

Document Name	Status

No forms / supporting documents in this ICR. Check IC Document Collections.

IC Document Collections

IC ID	Document Title	Status
102835	Civil Rights Title VI Form	Migrated

ICR Details

OMB Control No: 0584-0025	ICR Reference No: 199506-0584-006
Status: Historical Active	Previous ICR Reference No: 199403-0584-002
Agency/Subagency: USDA/FNS	Agency Tracking No:
Title: Civil Rights Title VI
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/14/1995
	Date Received in OIRA: 06/28/1995
Terms of Clearance: This collection is approved based on an agreement with FCS that, by October 1995, FCS will issue guidance to CSFP State/local agencies to clarify to them that they must complete the FCS-191 based upon self-identification by the participant and that visual identification can be used only in the case when an individual refuses to self-identify. This form is approved through 12/96 since FCS plans to revise this and other related forms during the next year. In addition, FCS will immediately modify the 191 to clarify that completion of the age and gender columns are optional. Respondents will only be required to complete column (E), total.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/1998	09/30/1998	09/30/1995
Responses	2,910	0	0
Time Burden (Hours)	6,531	0	6,710
Cost Burden (Dollars)	0	0	0

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Abstract: The FCS-191 form is used by CSFP local agencies to collect racial/ethnic data on each participant for one month of the year. The FCS-101 form is completed by FSP and FDPIR local agencies on all households for one month of the year. The data is used to monitor local agencies' compliance with the Civil Rights Act.

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Authorizing Statute(s): None

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Civil Rights Title VI	FCS-191, FCS-101

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ICR Summary of Burden

	Total Approved	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	2,910	0	0	0	2,910	0
Annual Time Burden (Hours)	6,531	6,710	0	0	-179	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: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $0

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

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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: 06/28/1995

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