Information Collection

Recordkeeping Only: Program & Budget Summary Statement FNS 366A; 366 B; SF 425

IC 2990 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⚠️ Notice: This information collection may be referencing outdated material.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 D FNS-366A Form.pdf Appendix D FNS-366A Form.pdf	IC Document
Appendix E FNS-366B Form.pdf Appendix E FNS-366B Form.pdf	IC Document
Appendix F SF 425-778.pdf Appendix F SF 425-778	IC Document
0584-0594 FPRS PBStatement _ExpDatDisplayed 9-30-2019.pdf FPRS PBS Currently at OMB under Review	IC Document

IC Title:

Recordkeeping Only: Program & Budget Summary Statement FNS 366A; 366 B; SF 425

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 7 CFR 274.2 7 CFR 272.2 7 CFR 274.12

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:

FR Citation:

Number of Respondents: 53

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	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	477	371	106
Annual IC Time Burden (Hours)	24	19	5
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Appendix D FNS-366A Form.pdf	Appendix D FNS-366A Form.pdf	07/07/2020
Appendix E FNS-366B Form.pdf	Appendix E FNS-366B Form.pdf	07/07/2020
Appendix F SF 425-778	Appendix F SF 425-778.pdf	07/07/2020
FPRS PBS Currently at OMB under Review	0584-0594 FPRS PBStatement _ExpDatDisplayed 9-30-2019.pdf	07/07/2020

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