Information Collection

WIC Federal and State Agreement

IC 43553 under ICR 201701-0584-001 · OMB 0584-0332.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0332 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form FNS 339 WIC Federal and State Agreement	Form and Instruction
FNS 339 Federal State Supplemental Nutrition Programs Agreement FNS-339 exp. 2-28-19 revision request Jan 2017.pdf www.fns.usda.gov/fns/forms.htm	Form and Instruction
Justification for Change Memo FNS-339.pdf Change Justification Memo for FNS 339	IC Document

IC Title:

WIC Federal and State Agreement

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

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 339	Federal State Supplemental Nutrition Programs Agreement	FNS-339 exp. 2-28-19 revision request Jan 2017.pdf	http://www.fns.usda.gov/fns/forms.htm	Yes	No	Fillable Printable

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 188

Number of Respondents for Small Entity: 56

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	124	124
Annual IC Time Burden (Hours)	31	31
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Change Justification Memo for FNS 339	Justification for Change Memo FNS-339.pdf	01/03/2017

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