Information Collection

Individuals/Households (OMB control number 0584-0074) REVISED FOR AE79

IC 238228 under ICR 201909-0584-003 · OMB 0584-0692.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
I- SORN FNS KC- 00-8005.pdf SORNS	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: Required to Obtain or Retain Benefits

CFR Citation: 7 CFR 275.12 (c)(1)

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: 59,146

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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	59,146	59,146
Annual IC Time Burden (Hours)	29,573	29,573
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SORNS	I- SORN FNS KC- 00-8005.pdf	10/03/2023

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