Information Collection

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IC 201916 under ICR 201212-0584-004 · OMB 0584-0568.

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 AppC1-Web Survey Login Screen Shots.pdf	Other-11/1/12 Web Survey Login Scree
SFIC Study OMB AppC2-School Foodservice Director Web Survey Screen Shots.pdf	Other-11/1/12 School Foodservice Dir
SFIC Study OMB AppC3-Public LEA Business Mgr Web Survey Screen Shots.pdf	Other-11/1/12 Public LEA Business Ma
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: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	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
Other-11/1/12 Web Survey Login Screen Shot	SFIC Study OMB AppC1-Web Survey Login Screen Shots.pdf		Yes	Yes	Fillable Fileable
Other-11/1/12 School Foodservice Director Web Survey Screen Shots	SFIC Study OMB AppC2-School Foodservice Director Web Survey Screen Shots.pdf		Yes	Yes	Fillable Fileable
Other-11/1/12 Public LEA Business Manager Web Survey Screen Shots	SFIC Study OMB AppC3-Public LEA Business Mgr Web Survey Screen Shots.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: 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	Previously Approved
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.