Change Justification Request to Consolidate FNS 683 & 203

United States

Department of

Agriculture

Food and

Nutrition

Service

3101 Park

Center Drive

Alexandria, VA

22302-1500

TO: Julie Wise

USDA, Office of Management and Budget Desk Officer

THROUGH: Ruth Brown

USDA, Office of the Chief Information Office Desk Officer

Rachelle Ragland-Greene
Information Clearance Officer

Office of Policy and Support/Planning and Regulatory Affairs

Janis Johnston

Acting Program Data Branch Chief

Office of Financial Management

FROM: Diane M. Kriviski
Acting Deputy Administrator
Supplemental Nutrition and Safety Programs

SUBJECT: Change Justification Request for Approval to the newly

Consolidated FNS 683 (WIC Farmers’ Market Nutrition Program

Annual Financial Report) and FNS 203 (WIC Farmers’ Market

Nutrition Program Report) Forms under Approved OMB

Clearance 0584-0447

The Food and Nutrition Service (FNS), Supplemental Food Programs Division is requesting approval to revise and consolidate FNS Forms 683 Worksheet (Financial Report) and 203 Worksheet (Program Report) which will streamline the reporting process.  Consolidating these worksheets will decrease the burden from this activity from 184 burden hours to 164.50. Additionally, with this consolidation, the FNS 203 will become obsolete and the revised FNS 683 is renamed WIC Farmers’ Market Nutrition Program Annual Financial and Program Data Report.  The reporting burden for the FNS 683 is contained in the Food Programs Reporting System (FPRS) OMB Control No.  0584-0594, Expiration Date:  6/30/2017. 

The target audience will not change. As mentioned above, the burden hours will decrease from the currently approved forms. Please see the following information for a detailed explanation regarding burden hours:

1. Number of Respondents: We anticipate that there will be a total of 47 respondents.

2. Time Needed per Response: To populate and submit the report, we anticipate it will take each respondent 3.50 hours.

Julie Wise

Page 2

3. Total Burden Hours on the Public: 164.50 hours total. Each respondent will complete and submit one form. The form will display the OMB control number and public burden statement.

Farmers Market Nutrition Program State Agencies will submit their annual closeout financial and program report using the FPRS. FNS reviews the information submitted in FPRS to determine if the data is accurate based on the awarded grant level. The data from the form will be used for administrative and informational purposes only.

Once OMB approves the newly consolidated FNS 683, the program will subsequently submit the form to the FNS Program Data Branch to be formatted/incorporated into FPRS.

Questions regarding this data collection request can be directed to: Donna Hines at 703-305-2714, or Teronica Nixon at 703-305-1746.

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