Information Collection

Business for-not-for-Profit (Respondents)

IC 233042 under ICR 201903-0584-001 · OMB 0584-0645.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
I. Observation Checklist.docx	Other-I. Observation Checklist.docx
K. E&T Provider Interview Protocol.docx	Other-K. E&T Provider Interview Prot
L. Admin Data Submission Instructions and Variable List.docx	Instruction
M.1. FTP Site instructions for submitting administrative data.docx snap.insightpolicyresearch.com	Other-M.1. FTP Site instructions for
J. Client Consent Form for Observations.docx J. Client Consent Form for Observations.docx	IC Document
M.2. Email to States with FTP Password.docx M.2. Email to States with FTP Password.docx	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-I. Observation Checklist.docx	I. Observation Checklist.docx		No		Paper Only
Other-K. E&T Provider Interview Protocol.docx	K. E&T Provider Interview Protocol.docx		No		Paper Only
Instruction	L. Admin Data Submission Instructions and Variable List.docx		No		Paper Only
Other-M.1. FTP Site instructions for submitting administrative data.docx	M.1. FTP Site instructions for submitting administrative data.docx	http://snap.insightpolicyresearch.com	Yes	Yes	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records

Title: USDA/FNS-10 Persons Doing Business with FNS

FR Citation: 65 FR 17251

Number of Respondents: 40

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	55	-15	70
Annual IC Time Burden (Hours)	72	-11	83
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
J. Client Consent Form for Observations.docx	J. Client Consent Form for Observations.docx	09/18/2018
M.2. Email to States with FTP Password.docx	M.2. Email to States with FTP Password.docx	09/18/2018

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