SNAProgram 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	Repair queued
Instruction-Help Guide.doc	Supplementary Document	Uploaded 2008-08-11	Available
Supporting Statement -OMB 584-0519 final 12-13-11.docx	Supporting Statement A	Uploaded 2011-12-14	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
3134	Supplemental Nutrition Assistance Program Pre-Screening Tool	Other-Website Screenshot	Modified

ICR Details

OMB Control No: 0584-0519	ICR Reference No: 201111-0584-005
Status: Historical Active	Previous ICR Reference No: 200804-0584-007
Agency/Subagency: USDA/FNS	Agency Tracking No:
Title: SNAProgram 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 without change	Conclusion Date: 01/30/2012
	Date Received in OIRA: 12/14/2011
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2015	36 Months From Approved	01/31/2012
Responses	396,000	0	264,000
Time Burden (Hours)	66,132	0	44,000
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 SNAP 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:
	76 FR 58237	09/20/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 239	12/13/2011
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
Supplemental Nutrition Assistance 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	396,000	264,000	0	0	132,000	0
Annual Time Burden (Hours)	66,132	44,000	0	0	22,132	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: No

Burden Reduction Due to:

Short Statement: FNS projects there is an annual burden adjustment of 66,132 hours representing an increase of 22,132 over the burden estimate of 44,000 hours used in the current approval of this information collection

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Annual Cost to Federal Government: $24,480

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]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

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: 12/14/2011

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