Information Collection

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IC 201916 under ICR 201204-0584-006 · OMB 0584-0568.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0568 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
SFIC Study OMB AppA-DataColl Instruments State and Local Govt.docx	Other-SFIC Study OMB AppA-DataColl I
SFIC Study OMB AppC-Web Survey Title Screen Local Govt.docx www.opinionport.com	Other-SFIC Study OMB AppC-Web Survey
SFIC Study OMB AppE-Notification Letters State and Local Govt.docx SFIC Study OMB AppE-Notification Letters State and Local Govt	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

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
Other-SFIC Study OMB AppA-DataColl Instruments State and Local Govt			SFIC Study OMB AppA-DataColl Instruments State and Local Govt.docx		No		Paper Only
Other-SFIC Study OMB AppC-Web Survey Title Screen Local Govt			SFIC Study OMB AppC-Web Survey Title Screen Local Govt.docx	www.opinionport.com	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: 4,862

Number of Respondents for Small Entity: 395

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 98 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	4,862	4,862
Annual IC Time Burden (Hours)	3,001	3,001
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SFIC Study OMB AppE-Notification Letters State and Local Govt	SFIC Study OMB AppE-Notification Letters State and Local Govt.docx	04/13/2012

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