Information Collection

Worksheet FNS 209 OMB# 0069

IC 204659 under ICR 201512-0584-008 · OMB 0584-0594.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0594 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form FNS 209 Screenshot Worksheet FNS 209 OMB# 0069	Form and Instruction
FNS 209 April 2014.pdf fprs.fns.usda.gov	Instruction
FNS 209 Screenshot Status of Claims Against Households FNS-209 Screenshots V2.pdf https:/fprs.fns.usda.gov	Form and Instruction

IC Title:

Worksheet FNS 209 OMB# 0069

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Mandatory

CFR Citation: 7 CFR 273.18

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
Form and Instruction	FNS 209 Screenshot	Status of Claims Against Households	FNS-209 Screenshots V2.pdf	https:/fprs.fns.usda.gov	Yes	Yes	Fillable Fileable Signable
Instruction			FNS 209 April 2014.pdf	https://fprs.fns.usda.gov	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: 53

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	212	212
Annual IC Time Burden (Hours)	636	636
Annual IC Cost Burden (Dollars)	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.