Information Collection

SNAP Waivers (WIMS) Template

IC 226456 under ICR 201910-0584-004 · OMB 0584-0083.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0083 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appendix G State Waiver Request Form.pdf www.under-reconstruction.gov	Other-SWIM online waiver form/databa
Appendix C System of Records Notice.pdf Appendix C System of Records Notice.pdf	IC Document

IC Title:

SNAP Waivers (WIMS) Template

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 7 CFR 272.3(b)(c)

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
Other-SWIM online waiver form/database			Appendix G State Waiver Request Form.pdf	www.under-reconstruction.gov	Yes	Yes	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records

Title: USDA/FNS 10 Persons Doing Business with FNS

FR Citation: 65 FR 17251

Number of Respondents: 45

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	177	-32	209
Annual IC Time Burden (Hours)	177	-32	209
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Appendix C System of Records Notice.pdf	Appendix C System of Records Notice.pdf	07/07/2020

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