Food Stamp Program Pre-Screening Tool

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
FNS�Screening Tool Tutorial - Printable Version.mht	Supplementary Document	Uploaded 2008-08-11	Source copy available
FAQ.doc	Supplementary Document	Uploaded 2008-08-11	Available
Instruction-Help Guide.doc	Supplementary Document	Uploaded 2008-08-11	Available
Prescreening Tool Survey 60 day burden hours.xls	Supplementary Document	Uploaded 2008-08-06	Available
Supporting Statement Justification 8-20-08.doc	Supporting Statement A	Uploaded 2008-08-20	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
3134	Food Stamp Program Pre-Screening Tool	Other-Web site	Modified

ICR Details

OMB Control No: 0584-0519	ICR Reference No: 200804-0584-007
Status: Historical Active	Previous ICR Reference No: 200505-0584-004
Agency/Subagency: USDA/FNS	Agency Tracking No:
Title: Food Stamp Program Pre-Screening Tool
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 12/07/2008
	Date Received in OIRA: 08/20/2008
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2011	36 Months From Approved	12/31/2008
Responses	264,000	0	264,000
Time Burden (Hours)	44,000	0	48,183
Cost Burden (Dollars)	0	0	0

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Abstract: The information collection involves the use of a web-based Pre-Screening tool for the general public to use to determine potential eligibility for Food Stamp Program benefits.

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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:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 33971	06/16/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 159	08/15/2008
Did the Agency receive public comments on this ICR? No

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

table that charts list of burden

IC Title	Form No.	Form Name
Food Stamp Program Pre-Screening Tool

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ICR Summary of Burden

table that charts list 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	264,000	264,000	0	0	0	0
Annual Time Burden (Hours)	44,000	48,183	0	-4,183	0	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The survey component of the tool was used for initial evaluation of the tool and was removed. FNS decreased its burden estimates by 4,183 due to a program change.

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Annual Cost to Federal Government: $31,512

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: 08/20/2008

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