Information Collection

State Agecny Reporting (Sampling Plan Activity PART 275 ) OMB 0584-0303 REVISED FOR AE79

IC 238225 under ICR 201909-0584-003 · OMB 0584-0692.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form FNS 74A State Agecny Reporting (Sampling Plan Activity PART 275 ) OMB 0584-0303 REVISED FOR AE79	Form and Instruction
Form FNS 74A State Agecny Reporting (Sampling Plan Activity PART 275 ) OMB 0584-0303 REVISED FOR AE79	Form and Instruction
FNS 74A QC-Related New Investment Plan FFY B. FNS-74A pending OMB approval.pdf snapqcs.fns.usda.gov/ (PLACEHOLDER UNTIL OMB APPROVES 0303)	Form and Instruction
FNS 74B QC New Investment Plan Progress Report FNS-74B.pdf snapqcs.fns.usda.gov/ (PLACEHOLDER UNTIL OMB APPROVES 0303)	Form and Instruction
Appendix E- FNS 311.pdf Appendix E FNS SNAP QC Sampling Handbook	IC Document

IC Title:

Agency IC Tracking Number:

Rev for only the hours needed for the merge

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 7 CFR 275.11(a)(1)-(a)(2) 7 CFR 275.11(a)(4)(i) 7 CFR 275.4

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 74A	QC-Related New Investment Plan FFY	B. FNS-74A pending OMB approval.pdf	https://snapqcs.fns.usda.gov/ (PLACEHOLDER UNTIL OMB APPROVES 0303)	Yes	Yes	Fillable Fileable Signable
Form and Instruction	FNS 74B	QC New Investment Plan Progress Report	FNS-74B.pdf	https://snapqcs.fns.usda.gov/ (PLACEHOLDER UNTIL OMB APPROVES 0303)	Yes	Yes	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records

Title: USDA.FNS-5 Information on Persons Disqualified from the Supplemental Nutrition Assistance Program

FR Citation: 75 FR 81205

Number of Respondents: 53

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	246	246
Annual IC Time Burden (Hours)	2,829	2,829
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Appendix E FNS SNAP QC Sampling Handbook	Appendix E- FNS 311.pdf	01/14/2020

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