Information Collection

Summer Food Service Program Claim for Reimbursement

IC 2925 under ICR 200609-0584-011 · OMB 0584-0041.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0041 can be found here:

Documents and Forms

Document Name Document Type
Form FNS-143 (electroni Summer Food Service Program Claim for Reimbursement Form
FNS-143 Claim for Reimbursement FNS-143.pdf Form
FNS-143 (electroni Claim for Reimbursement FNS-143 e-Form.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Summer Food Service Program Claim for Reimbursement	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 7 CFR 225.6, 225.9, 225.10, & 225.15

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	FNS-143 (electronic)	Claim for Reimbursement	FNS-143 e-Form.pdf		Yes	Yes	Fillable Fileable
Form	FNS-143	Claim for Reimbursement	FNS-143.pdf		Yes	Yes	Printable Only

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 123	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 50 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	615	-445	1,060
Annual IC Time Burden (Hours)	423	-187	610
Annual IC Cost Burden (Dollars)	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.