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

Operating Guidelines, Forms, and Waivers, Program and Budget Summary Statement (Forms FNS-366A &FNS-366B)

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

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:

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 %

	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

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.