Information Collection

CACFP Characteristics - State Government

IC 213732 under ICR 201612-0584-002 · OMB 0584-0601.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
B1 State CACFP Agency Letter.docx	Other-B1 State CACFP Agency Letter
B2 Provider Sample Sponsor Letter.docx	Other-B2 Provider Sample Sponsor Let
OMB Exhibit 6 State Agency Web Survey Final.docx	Other-Exhibit 6: State Agency Web Su
OMB Exhibit 5 State Agency Email Final.docx Exhibit 5: State Agency Email	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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-B1 State CACFP Agency Letter	B1 State CACFP Agency Letter.docx	No		Paper Only
Other-B2 Provider Sample Sponsor Letter	B2 Provider Sample Sponsor Letter.docx	No		Paper Only
Other-Exhibit 6: State Agency Web Survey	OMB Exhibit 6 State Agency Web Survey Final.docx	Yes	Yes	Fillable Fileable

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 196

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	236	40	196
Annual IC Time Burden (Hours)	413	21	392
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Exhibit 5: State Agency Email	OMB Exhibit 5 State Agency Email Final.docx	12/20/2016

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