State/Local: D - SFA Reimbursement Claims Data

Third Access, Participation, Eligibility and Certification Study Series (APEC III)

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

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:

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 %

	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

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.