Information Collection

Worksheet FNS 759 OMB# 0594 formerly 0542

IC 204673 under ICR 201701-0584-003 · OMB 0584-0594.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0594 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Revised FNS-759 Form Finalized for OMB Submission June 20 2016.pdf fprs.fns.usda.gov	Other-FNS 759 Worksheet

IC Title:

Worksheet FNS 759 OMB# 0594 formerly 0542

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Mandatory

CFR Citation: 7 CFR 275.3

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
Other-FNS 759 Worksheet			Revised FNS-759 Form Finalized for OMB Submission June 20 2016.pdf	https://fprs.fns.usda.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: 52

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	52	52
Annual IC Time Burden (Hours)	3,180	3,180
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.