Food Stamp Forms: Applications, Periodic Reporting, Notices

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
022113 0584-0064 Change Worksheet.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2013-02-21	Repair queued
Change in Burden Requirements OMB 584-0064 - Justification-signedmemo 9-2010.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2010-09-29	Available
Burden_Summary_0584-0064 2-23-2010 revised.xls	Supplementary Document	Uploaded 2010-02-23	Available
Attachment G - Burden Narrative Associated with 0584-0064 1.11.10.doc	Supplementary Document	Uploaded 2010-01-11	Available
Supporting_Statement_2-22-2010.docx	Supporting Statement A	Uploaded 2010-02-25	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
2960	State: Applications, Periodic Reporting, Notices		Modified
182154	Local Agencies Recordkeeping		Unchanged
182153	Household/Individual: Application & Periodic Reporting		Unchanged

ICR Details

OMB Control No: 0584-0064	ICR Reference No: 201302-0584-008
Status: Historical Active	Previous ICR Reference No: 201009-0584-001
Agency/Subagency: USDA/FNS	Agency Tracking No:
Title: Food Stamp Forms: Applications, Periodic Reporting, Notices
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 02/22/2013
	Date Received in OIRA: 02/21/2013
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2013	03/31/2013	03/31/2013
Responses	294,426,292	0	294,426,292
Time Burden (Hours)	24,897,947	0	24,898,223
Cost Burden (Dollars)	0	0	0

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Abstract: Information collected is used to determine eligibility and participation in the food stamp program. Certifications and periodic reporting are to verify current eligibility.

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Authorizing Statute(s): PL: Pub.L. 108 - 267 3, 5, 11 Name of Law: The Food Stamp Act of 1977
   PL: Pub.L. 107 - 171 Title IV Subtitle A Name of Law: FSRIA 2002
   PL: Pub.L. 104 - 193 Title IV Name of Law: PRWORA
   PL: Pub.L. 104 - 208 Title I Name of Law: Omnibus Consoidated Appropriations Act
   PL: Pub.L. 105 - 185 Title IV Name of Law: Ag Research, Extension, & Education Reform Act of 1998
   US Code: 33 USC 2701(31) Name of Law: Oil Pollution Act of 1990 (OPA90)
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0584-AD30	Final or interim final rulemaking	75 FR 19	01/29/2010

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	69 FR 20724	04/16/2004
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 3

table that charts list of burden

IC Title	Form No.	Form Name
State: Applications, Periodic Reporting, Notices
Household/Individual: Application & Periodic Reporting
Local Agencies Recordkeeping

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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	294,426,292	294,426,292	0	0	0	0
Annual Time Burden (Hours)	24,897,947	24,898,223	0	0	-276	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: The OMB term of clearance for 0584-0064, approved for three years on October 4, 2010, was that FNS would merge 276 burden hours from 0584-0064 to 0584-0083 and 0584-0496 as described in the ICR. This is a no material/non-substantive change to complete the merge.

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Annual Cost to Federal Government: $6,855,727

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: 02/21/2013

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