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FNS-843, FNS 844 (State Agencies)
CACFP National Disqualified List - Forms FNS-843, FNS-844
OMB: 0584-0584
IC ID: 206841
OMB.report
USDA/FNS
OMB 0584-0584
ICR 201607-0584-001
IC 206841
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0584 can be found here:
2023-07-31 - Extension without change of a currently approved collection
2022-03-31 - No material or nonsubstantive change to a currently approved collection
Documents and Forms
Document Name
Document Type
Form FNS-844 (online)
FNS-843, FNS 844 (State Agencies)
Form
FNS-843 (online) FNS-843 Report of Disqualification from Participation -
Attachment A-1 FNS-843.docx
www.fns.usda.gov
Form
FNS-844 (online) Report of Disqualification from Participation - Individu
Attachment A-2 FNS-844.docx
www.fns.usda.gov
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
FNS-843, FNS 844 (State Agencies)
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Mandatory
CFR Citation:
7 CFR 226.6(c)(7)
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
FNS-844 (online)
Report of Disqualification from Participation - Individually Disqualified Responsible Principal/Individual or Day Care Home Provider
Attachment A-2 FNS-844.docx
www.fns.usda.gov
Yes
Yes
Fillable Fileable
Form
FNS-843 (online)
FNS-843 Report of Disqualification from Participation - Institution and Responsible Principals/Individuals
Attachment A-1 FNS-843.docx
www.fns.usda.gov
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Income Security
Subfunction:
Food and Nutrition Assistance
Privacy Act System of Records
Title:
USDA/FNS-11 Information on Persons Identified as Responsible for Serious Deficiencies, Proposed for Disqualification, or Disqualified to Participate as Principals or Family Day Care Home Operators in
FR Citation:
69 FR 6933
Number of Respondents:
56
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
100 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
1,568
0
0
0
0
1,568
Annual IC Time Burden (Hours)
784
0
0
0
0
784
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
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.