Information Collection

State Agencies

IC 198836 under ICR 201108-0584-001 · OMB 0584-0566.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appendix A2- State Agency Data Request Materials.pdf	Other-State Agency Data Request Mate
Appendix A State Recruitment and Data Request Materials final 01-26-2012.doc	Other-Appendix A State Recruitment a
Appendix A State Recruitment and Data Request Materials final 2-14-2012.doc	Other-Appendix A State Recruitment a
Appendix A1 -- State Agency Contact Letter.pdf State Agency Contact Letter.	IC Document

IC Title:

State Agencies

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Electronic Capability
Other-State Agency Data Request Materials	Appendix A2- State Agency Data Request Materials.pdf	No	Paper Only
Other-Appendix A State Recruitment and Data Request Materials final 01-26-2012	Appendix A State Recruitment and Data Request Materials final 01-26-2012.doc	No	Paper Only
Other-Appendix A State Recruitment and Data Request Materials final 2-14-2012	Appendix A State Recruitment and Data Request Materials final 2-14-2012.doc	No	Paper Only

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 16

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
Annual Number of Responses for this IC	30	30
Annual IC Time Burden (Hours)	19	19
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
State Agency Contact Letter.	Appendix A1 -- State Agency Contact Letter.pdf	08/12/2011

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