Information Collection

Worksheet FNS 366A and 366B OMB# 0083

IC 204662 under ICR 201703-0584-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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
Form FNS 366 A Worksheet FNS 366A and 366B OMB# 0083	Form and Instruction
FNS 366a April 2014.pdf fprs.fns.usda.gov	Instruction
FNS 366 A Program and Budget Summary Statement: Budget Projection FNS-366A Screenshots.pdf fprs.fns.usda.gov	Form and Instruction
FNS 366 B PROGRAM AND BUDGET SUMMARY STATEMENT PART B - PROGRAM AC Revised FNS 366 B Form-Instruction Edits 9-19-16.pdf www.fprs.gov	Form and Instruction
Att-1 FPRS Burden Chart 366B.xlsx FNS 366 B Burden	IC Document

IC Title:

Worksheet FNS 366A and 366B OMB# 0083

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Mandatory

CFR Citation: 7 CFR 272.2

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 366 A	Program and Budget Summary Statement: Budget Projection	FNS-366A Screenshots.pdf	https://fprs.fns.usda.gov	Yes	Yes	Fillable Fileable Signable
Form and Instruction	FNS 366 B	PROGRAM AND BUDGET SUMMARY STATEMENT PART B - PROGRAM ACTIVITY STATEMENT	Revised FNS 366 B Form-Instruction Edits 9-19-16.pdf	www.fprs.gov	Yes	Yes	Fillable Fileable Signable
Instruction			FNS 366a April 2014.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: 53

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	106	106
Annual IC Time Burden (Hours)	5,486	5,486
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
FNS 366 B Burden	Att-1 FPRS Burden Chart 366B.xlsx	01/21/2016

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