Information Collection

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

IC 238226 under ICR 201909-0584-003 · OMB 0584-0692.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appendix E Handbook 311.doc.pdf Appendix E Sampling QC Handbook for Part 275	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

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

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	53	53
Annual IC Time Burden (Hours)	2,120	2,120
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Appendix E Sampling QC Handbook for Part 275	Appendix E Handbook 311.doc.pdf	09/09/2020

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