Information Collection

State Agencies, Grantees and SFA

IC 196143 under ICR 201402-0584-004 · OMB 0584-0559.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appendix C SEBTC State Agency interview guide 3-12-14.docx	Other-Appendix C SEBTC State Agency
Attachment A Recruitment Letter Implementation Interview 3-5-14.docx Attachment A: Recruitment Advance Letter State Agencies	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

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-Appendix C SEBTC State Agency interview guide 3-5-14			Appendix C SEBTC State Agency interview guide 3-12-14.docx		No		Paper Only

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 13

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	Previously Approved
Annual Number of Responses for this IC	13	-106	119
Annual IC Time Burden (Hours)	13	-206	219
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment A: Recruitment Advance Letter State Agencies	Attachment A Recruitment Letter Implementation Interview 3-5-14.docx	03/11/2014

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