Information Collection

Supplemental Nutrition Assistance Program Pre-Screening Tool

IC 3134 under ICR 201408-0584-003 · OMB 0584-0519.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Screen shots V3 English 1-21-15.docx www.snap-step1.usda.gov	Other-Website English Screenshot
SNAP Pre-Screening Tool - Spanish 1-21-15.pdf www.snap-step1.usda.gov/fns/index.jsp	Other-Website Spanish Screenshots

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 7 CFR 243.9 Section 5

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-Website English Screenshot				www.snap-step1.usda.gov	Yes	Yes	Fillable Fileable Signable
Other-Website Spanish Screenshots				http://www.snap-step1.usda.gov/fns/index.jsp	Yes	Yes	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records

Title: USDA/FNS-10 Persons Doing Business with FNS

FR Citation: 65 FR 17251

Number of Respondents: 402,534

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	402,534	6,534	396,000
Annual IC Time Burden (Hours)	67,223	1,091	66,132
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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

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