Information Collection

Monthly Claim for Reimbursement FNS 806-A & B

IC 3005 under ICR 200912-0584-003 · OMB 0584-0284.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0284 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form FNS 806-A Monthly Claim for Reimbursement FNS 806-A & B	Form and Instruction
FNS 806-A School Lunch/Breakfast/Snack Claim for Reimbursement FNS-806 A 12-2009.pdf	Form and Instruction
FNS 806-A (Electro School Lunch/Breakfast/Snack Claim for Reimbursement FNS 806-A (electronic).pdf	Form and Instruction
FNS 806-B Milk Claim for Reimbursement FNS 806-B.pdf	Form and Instruction
FNS 806-B Milk Claim for Reimbursement FNS 806-B (electronic).pdf	Form and Instruction

IC Title:

Monthly Claim for Reimbursement FNS 806-A & B

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	FNS 806-A	School Lunch/Breakfast/Snack Claim for Reimbursement	FNS-806 A 12-2009.pdf	No		Printable Only
Form and Instruction	FNS 806-A (Electronic)	School Lunch/Breakfast/Snack Claim for Reimbursement	FNS 806-A (electronic).pdf	Yes	Yes	Fillable Printable
Form and Instruction	FNS 806-B	Milk Claim for Reimbursement	FNS 806-B.pdf	No		Printable Only
Form and Instruction	FNS 806-B	Milk Claim for Reimbursement	FNS 806-B (electronic).pdf	Yes	Yes	Fillable Printable

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 233

Number of Respondents for Small Entity: 233

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	Previously Approved
Annual Number of Responses for this IC	2,796	66	2,730
Annual IC Time Burden (Hours)	1,398	-498	1,896
Annual IC Cost Burden (Dollars)	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.