Information Collection

Worksheet FNS 777 OMB# 0067

IC 204658 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⚠️ Notice: This information collection may be referencing outdated material.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 FNS777 (screenshot Worksheet FNS 777 OMB# 0067	Form and Instruction
FNS 777.pdf	Instruction
FNS 777 (screensho Financial Status Report 777_Page1_1.jpg fprs.fns.usda.gov	Form and Instruction
FNS777 (screenshot Financial Status Report 777_Page1_2.jpg fprs.fns.usda.gov	Form and Instruction
FNS777 (screenshot Financial Status Report 777_Page2_1.jpg fprs.fns.usda.gov	Form and Instruction
FNS777 (screenshot Financial Status Report 777_Page2_2.jpg fprs.fns.usda.gov	Form and Instruction
FNS777 (screenshot Financial Status Report 777_Page3_1.jpg fprs.fns.usda.gov	Form and Instruction
FNS777 (screenshot Financial Status Report 777_Page3_2.jpg fprs.fns.usda.gov	Form and Instruction
FNS777 (screenshot Financial Status Report 777_Remarks.jpg fprs.fns.usda.gov	Form and Instruction
FNS777 (screenshot Financial Status Report 777SAE_Page1_1.jpg fprs.fns.usda.gov	Form and Instruction
FNS777 (screenshot Financial Status Report 777SAE_Page1_2.jpg fprs.fns.usda.gov	Form and Instruction
FNS777 (screenshot Financial Status Report 777SAE_Page2_1.jpg fprs.fns.usda.gov	Form and Instruction
FNS777 (screenshot Financial Status Report 777SAE_Page2_2.jpg fprs.fns.usda.gov	Form and Instruction
FNS777 (screenshot Financial Status Report 777SAE_Page3_1.jpg fprs.fns.usda.gov	Form and Instruction
FNS777 (screenshot Financial Status Report 777SAE_Page3_2.jpg fprs.fns.usda.gov	Form and Instruction
FNS777 (screenshot Financial Status Report 777SAE_Remarks.jpg fprs.fns.usda.gov	Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Worksheet FNS 777 OMB# 0067

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 7 CFR 235.7

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	FNS777 (screenshot 2)	Financial Status Report	777_Page1_2.jpg	https://fprs.fns.usda.gov	Yes	Yes	Fillable Fileable Signable
Form and Instruction	FNS777 (screenshot 3)	Financial Status Report	777_Page2_1.jpg	https://fprs.fns.usda.gov	Yes	Yes	Fillable Fileable Signable
Form and Instruction	FNS777 (screenshot 4)	Financial Status Report	777_Page2_2.jpg	https://fprs.fns.usda.gov	Yes	Yes	Fillable Fileable Signable
Form and Instruction	FNS777 (screenshot 5)	Financial Status Report	777_Page3_1.jpg	https://fprs.fns.usda.gov	Yes	Yes	Fillable Fileable Signable
Form and Instruction	FNS777 (screenshot 6)	Financial Status Report	777_Page3_2.jpg	https://fprs.fns.usda.gov	Yes	Yes	Fillable Fileable Signable
Form and Instruction	FNS777 (screenshot 7)	Financial Status Report	777_Remarks.jpg	https://fprs.fns.usda.gov	Yes	Yes	Fillable Fileable Signable
Form and Instruction	FNS777 (screenshot 8)	Financial Status Report	777SAE_Page1_1.jpg	https://fprs.fns.usda.gov	Yes	Yes	Fillable Fileable Signable
Form and Instruction	FNS777 (screenshot 9)	Financial Status Report	777SAE_Page1_2.jpg	https://fprs.fns.usda.gov	Yes	Yes	Fillable Fileable Signable
Form and Instruction	FNS777 (screenshot 10)	Financial Status Report	777SAE_Page2_1.jpg	https://fprs.fns.usda.gov	Yes	Yes	Fillable Fileable Signable
Form and Instruction	FNS777 (screenshot 11)	Financial Status Report	777SAE_Page2_2.jpg	https://fprs.fns.usda.gov	Yes	Yes	Fillable Fileable Signable
Form and Instruction	FNS777 (screenshot 12)	Financial Status Report	777SAE_Page3_1.jpg	https://fprs.fns.usda.gov	Yes	Yes	Fillable Fileable Signable
Form and Instruction	FNS777 (screenshot 13)	Financial Status Report	777SAE_Page3_2.jpg	https://fprs.fns.usda.gov	Yes	Yes	Fillable Fileable Signable
Form and Instruction	FNS777 (screenshot 14)	Financial Status Report	777SAE_Remarks.jpg	https://fprs.fns.usda.gov	Yes	Yes	Fillable Fileable Signable
Instruction			FNS 777.pdf		Yes	Yes	Fillable Fileable Signable
Form and Instruction	FNS 777 (screenshot 1)	Financial Status Report	777_Page1_1.jpg	https://fprs.fns.usda.gov	Yes	Yes	Fillable Fileable Signable

Federal Enterprise Architecture Business Reference Module

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 87

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	348	348
Annual IC Time Burden (Hours)	174	174
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.