Information Collection

Worksheet FNS 152, 153 & 667 OMB# 0293

IC 204625 under ICR 201904-0584-002 · 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⚠️ Notice: This information collection may be referencing outdated material.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 152 (screensho Worksheet FNS 152, 153 & 667 OMB# 0293	Form and Instruction
FNS-153.pdf fprs.fns.usda.gov	Instruction
FNS 667.pdf fprs.fns.usda.gov	Instruction
FNS 152 (screensho Monthly Distribution of Donated Food to Family Units FDPIR-FNS-152 TAB1.jpg fprs.fns.usda.gov/Home/Reminder.aspx	Form and Instruction
FNS 153 (screensho Monthly Report of the CSFP and Quarterly Administrative CSFP-FNS-153 TAB1.jpg fprs.fns.usda.gov/Home/Reminder.aspx	Form and Instruction
FNS 667 (screensho Report of The Emergency Food Assistance Programs (TEFAP) TEFAP FNS-667.jpg fprs.fns.usda.gov/Home/Reminder.aspx	Form and Instruction
FNS 152 (screensho Monthly Distribution of Donated Food to Family Units FDPIR-FNS-152 TAB2.jpg fprs.fns.usda.gov	Form and Instruction
FNS 153 (screensho Monthly Report of the CSFP and Quarterly Administrative CSFP-FNS-153 TAB2.jpg fprs.fns.usda.gov	Form and Instruction
FNS 667 (remarks s Report of The Emergency Food Assistance Program (TEFAP) TEFAP FNS-667 Remarks.jpg fprs.fns.usda.gov	Form and Instruction

IC Title:

Worksheet FNS 152, 153 & 667 OMB# 0293

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 7 CFR 251.10 7 CFR 250.17

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 152 (screenshot 2)	Monthly Distribution of Donated Food to Family Units	FDPIR-FNS-152 TAB2.jpg	https://fprs.fns.usda.gov	Yes	Yes	Fillable Fileable Signable
Instruction			FNS-153.pdf	https://fprs.fns.usda.gov	Yes	Yes	Fillable Fileable Signable
Instruction			FNS 667.pdf	https://fprs.fns.usda.gov	Yes	Yes	Fillable Fileable Signable
Form and Instruction	FNS 153 (screenshot 2)	Monthly Report of the CSFP and Quarterly Administrative Financial Status Report	CSFP-FNS-153 TAB2.jpg	https://fprs.fns.usda.gov	Yes	Yes	Fillable Fileable Signable
Form and Instruction	FNS 667 (remarks section)	Report of The Emergency Food Assistance Program (TEFAP) Administrative Costs	TEFAP FNS-667 Remarks.jpg	https://fprs.fns.usda.gov	Yes	Yes	Fillable Fileable Signable
Form and Instruction	FNS 152 (screenshot 1)	Monthly Distribution of Donated Food to Family Units	FDPIR-FNS-152 TAB1.jpg	https://fprs.fns.usda.gov/Home/Reminder.aspx	Yes	Yes	Fillable Fileable Signable
Form and Instruction	FNS 153 (screenshot 1)	Monthly Report of the CSFP and Quarterly Administrative Financial Status Report	CSFP-FNS-153 TAB1.jpg	https://fprs.fns.usda.gov/Home/Reminder.aspx	Yes	Yes	Fillable Fileable Signable
Form and Instruction	FNS 667 (screenshot)	Report of The Emergency Food Assistance Programs (TEFAP) Administrative Costs	TEFAP FNS-667.jpg	https://fprs.fns.usda.gov/Home/Reminder.aspx	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: 115

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	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	2,614	503	2,111
Annual IC Time Burden (Hours)	9,684	2,216	7,468
Annual IC Cost Burden (Dollars)	0	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.