Information Collection

State/Local: D - SFA Reimbursement Claims Data

IC 203781 under ICR 201705-0584-004 · OMB 0584-0530.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0530 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
rev062112 Attachment D.1-SFA Reimbursement Claim Verif Form-Month.doc	Other-Attachment D.1-SFA Reimburseme
rev062112 Attachment D.2-SFA Reimbursement Claim Verif Form-Week.doc	Other-Attachment D.2-SFA Reimburseme
rev062112 Attachment D.3-SFA Reimbursement Claim Verif Form-For All Schools.doc	Other-Attachment D.3 - Optional SFA

IC Title:

State/Local: D - SFA Reimbursement Claims Data

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Electronic Capability
Other-Attachment D.1-SFA Reimbursement Claim Verif - Month	rev062112 Attachment D.1-SFA Reimbursement Claim Verif Form-Month.doc	No	Paper Only
Other-Attachment D.2-SFA Reimbursement Claim Verif - Week	rev062112 Attachment D.2-SFA Reimbursement Claim Verif Form-Week.doc	No	Paper Only
Other-Attachment D.3 - Optional SFA Reimbursement Claim Verif Form-For All Schools	rev062112 Attachment D.3-SFA Reimbursement Claim Verif Form-For All Schools.doc	No	Paper Only

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 139

Number of Respondents for Small Entity: 14

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-139	139
Annual IC Time Burden (Hours)	-139	139
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.