Information Collection

Food Back Pack

IC 194669 under ICR 200906-0584-002 · OMB 0584-0512.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0512 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SF LLL Food Back Pack	Form and Instruction
SF LLL DISCLOSURE OF LOBBYING ACTIVITIES SF-LLL.pdf www.grants.gov	Form and Instruction
SF 425 Federal Financial Report SF-425.pdf www.grants.gov	Form
SF 425A Federal Financial Report SF-425A.pdf www.grants.gov	Form
Solicitation_for_State_Agencies_-_2011_SFSP_demos_10 5 10 no highlights.doc Request for Applications (RFA)	IC Document
Request of Approval to Add Grant to OMB Docket Memo 9.16.2010.doc Memo	IC Document
Home Delivery and Food Backpack SS Justification 10 5 10.doc Supporting Statement	IC Document
SF-424.pdf SF 424	IC Document
SF-424A.pdf SF 424A	IC Document
SF-424B.pdf SF 424B	IC Document
AD1047-F-01-92.pdf AD1047	IC Document
AD-1052.pdf AD 1052	IC Document

IC Title:

Food Back Pack

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	SF LLL	DISCLOSURE OF LOBBYING ACTIVITIES	SF-LLL.pdf	http://www.grants.gov	Yes	Yes	Fillable Fileable Signable
Form	SF 425	Federal Financial Report	SF-425.pdf	http://www.grants.gov	Yes	Yes	Fillable Fileable Signable
Form	SF 425A	Federal Financial Report	SF-425A.pdf	http://www.grants.gov	Yes	Yes	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 30

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	58	58
Annual IC Time Burden (Hours)	3,301	3,301
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Request for Applications (RFA)	Solicitation_for_State_Agencies_-_2011_SFSP_demos_10 5 10 no highlights.doc	10/06/2010
Memo	Request of Approval to Add Grant to OMB Docket Memo 9.16.2010.doc	09/27/2010
Supporting Statement	Home Delivery and Food Backpack SS Justification 10 5 10.doc	10/06/2010
SF 424	SF-424.pdf	09/27/2010
SF 424A	SF-424A.pdf	09/27/2010
SF 424B	SF-424B.pdf	09/27/2010
AD1047	AD1047-F-01-92.pdf	09/27/2010
AD 1052	AD-1052.pdf	09/27/2010

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