Information Collection

State Agencies

IC 227921 under ICR 201702-0584-002 · OMB 0584-0631.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
APPENDIX V- STATE AGENCY ADMINISTRATIVE CASE RECORD DATA.docx	Other-Appendix V State Agency Admins

IC Title:

State Agencies

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

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
Other-Appendix V State Agency Adminstrative Case Record Data			APPENDIX V- STATE AGENCY ADMINISTRATIVE CASE RECORD DATA.docx		No		Paper Only

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 26

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
Annual Number of Responses for this IC	26	26
Annual IC Time Burden (Hours)	26	26
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.