Information Collection

State and Local Burden

IC 2879 under ICR 201606-0584-007 · OMB 0584-0006.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0006 can be found here:

Documents and Forms

Document Name Document Type
Form FNS-640 State and Local Burden Form and Instruction
Attachment F 0584-0594 FPRS PBStatement _ExpDatDisplayed 7-16-14.pdf www.fprs.gov Other-Attachment F 0584-0594 FPRS PB
Attachment G FNS-10 Screenshots V2.pdf www.fprs.gov Other-Attachment G FNS-10 Screenshot
Attachment H FNS-13 Screenshots V2.pdf www.fprs.gov Other-Attachment H FNS-13 Screenshot
Attachment I FNS-828_OMB_0584-0594.pdf www.fprs.gov Other-Attachment I FNS-828_OMB_0584-
Attachment J FNS-777 Screenshots.pdf www.fprs.gov Other-Attachment J FNS-777 Screensho
FNS-640 Coordinated Review Effort (CRE) Data Report FNS 640 - Administrative Review Report_8 22_16 OMB.xlsx Form and Instruction
Attachment A FNS-10 Screenshots V2.pdf Attachment A FNS-10 Report of School Program Operations IC Document
Attachment B FNS-13 Screenshots V2.pdf Attachment B FNS-13 Annual Report of State Revenue Matching IC Document
Attachment C FNS-777 Screenshots.pdf Attachment C FNS-777 Financial Status Report IC Document
Attachment D FNS-828_OMB_0584-0594.pdf Attachment D FNS-828 School Food Authority Paid Lunch Price Report IC Document
Attachment E 0584-0594 FPRS PBStatement _ExpDatDisplayed 7-16-14.pdf Attachment E OMB# 0584-0594 Food Programs Reporting System (FPRS) Home Screen with OMB Information and Public Burden Statement IC Document
Attachment F FNS-66A NSLP, Breakfast, and Commodity School Application.pdf Attachment F FNS-66A National School Lunch, Breakfast, and Commodity School Application IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	State and Local Burden	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 7 CFR 210

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	FNS-640	Coordinated Review Effort (CRE) Data Report	FNS 640 - Administrative Review Report_8 22_16 OMB.xlsx		No		Paper Only
Other-Attachment F 0584-0594 FPRS PBStatement _ExpDatDisplayed 7-16-14			Attachment F 0584-0594 FPRS PBStatement _ExpDatDisplayed 7-16-14.pdf	www.fprs.gov	Yes	Yes	Fillable Fileable Signable
Other-Attachment G FNS-10 Screenshots V2			Attachment G FNS-10 Screenshots V2.pdf	www.fprs.gov	Yes	Yes	Fillable Fileable Signable
Other-Attachment H FNS-13 Screenshots V2			Attachment H FNS-13 Screenshots V2.pdf	www.fprs.gov	Yes	Yes	Fillable Fileable Signable
Other-Attachment I FNS-828_OMB_0584-0594			Attachment I FNS-828_OMB_0584-0594.pdf	www.fprs.gov	Yes	Yes	Fillable Fileable Signable
Other-Attachment J FNS-777 Screenshots			Attachment J FNS-777 Screenshots.pdf	www.fprs.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: 121,210	Number of Respondents for Small Entity: 120,758

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 2 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	49,756,388	6,888	49,749,500
Annual IC Time Burden (Hours)	9,873,218	1,823	9,871,395
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment A FNS-10 Report of School Program Operations	Attachment A FNS-10 Screenshots V2.pdf	02/23/2016
Attachment B FNS-13 Annual Report of State Revenue Matching	Attachment B FNS-13 Screenshots V2.pdf	02/23/2016
Attachment C FNS-777 Financial Status Report	Attachment C FNS-777 Screenshots.pdf	02/23/2016
Attachment D FNS-828 School Food Authority Paid Lunch Price Report	Attachment D FNS-828_OMB_0584-0594.pdf	02/23/2016
Attachment E OMB# 0584-0594 Food Programs Reporting System (FPRS) Home Screen with OMB Information and Public Burden Statement	Attachment E 0584-0594 FPRS PBStatement _ExpDatDisplayed 7-16-14.pdf	02/26/2016
Attachment F FNS-66A National School Lunch, Breakfast, and Commodity School Application	Attachment F FNS-66A NSLP, Breakfast, and Commodity School Application.pdf	02/23/2016

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