Information Collection

Summer Food Service Program Claim for Reimbursement

IC 2925 under ICR 200911-0584-001 · OMB 0584-0041.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form FNS-143 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

IC Title:

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:

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

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 111

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	333	0	-282	615
Annual IC Time Burden (Hours)	167	-115	-141	423
Annual IC Cost Burden (Dollars)	0	0	0	0

Documents for IC

table that charts IC Documents
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.