Information Collection

State CN Agency

IC 222035 under ICR 201606-0584-006 · OMB 0584-0618.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appendix B01 State Notification Letter & Administrative Data Request.docx	Other-Appendix B1 Sate Notification
Appendix B06 State Sample Selection Notification Letter (Notifying State of Sampled Sponsors-Centers).docx	Other-Appendix B6 State Sample Selec
Appendix C18 State Meal Claim Request.docx	Other-Appendix C18 State Meal Claim
Appendix B02 State Instructions for Submission of Administrative Data.docx Appendix B2 State Instructions for Submission of Administrative Data	IC Document
Appendix B03 State User Account Sheet.docx Appendix B3 State User Account Sheet	IC Document
Appendix B04 Guidelines for the EPICCS Administrative Data Request.docx Appendix B4 Guidelines for the EPICCS Administrative Data Request	IC Document
Appendix B05 Confirmation Email (Confirming Data File is Complete).docx Appendix B5 Confirmation Email (Confirming Data File is Complete)	IC Document
Appendix B07 Template Letter from State to Sponsors (Notification of Selection for Study).docx Appendix B7 Template Letter from State to Sponsors (Notification of Selection for Study)	IC Document

IC Title:

State CN Agency

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Appendix B1 Sate Notification Letter & Administrative Data Request	Appendix B01 State Notification Letter & Administrative Data Request.docx	Yes	Yes	Fillable Fileable
Other-Appendix B6 State Sample Selection Notification Letter (Notifying State of Sampled Sponsors/Centers)	Appendix B06 State Sample Selection Notification Letter (Notifying State of Sampled Sponsors-Centers).docx	No		Paper Only
Other-Appendix C18 State Meal Claim Request	Appendix C18 State Meal Claim Request.docx	Yes	Yes	Fillable Fileable

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records

Title: FNS-8 USDA/FNS Studies and Reports

FR Citation: 56 FR 19078

Number of Respondents: 50

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 13 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	200	200
Annual IC Time Burden (Hours)	275	275
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Appendix B2 State Instructions for Submission of Administrative Data	Appendix B02 State Instructions for Submission of Administrative Data.docx	06/22/2016
Appendix B3 State User Account Sheet	Appendix B03 State User Account Sheet.docx	06/22/2016
Appendix B4 Guidelines for the EPICCS Administrative Data Request	Appendix B04 Guidelines for the EPICCS Administrative Data Request.docx	06/22/2016
Appendix B5 Confirmation Email (Confirming Data File is Complete)	Appendix B05 Confirmation Email (Confirming Data File is Complete).docx	06/22/2016
Appendix B7 Template Letter from State to Sponsors (Notification of Selection for Study)	Appendix B07 Template Letter from State to Sponsors (Notification of Selection for Study).docx	06/22/2016

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