Information Collection

Food Distribution Program (State and Local Government)

IC 43552 under ICR 201911-0584-003 · OMB 0584-0293.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0293 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form FNS-7 Destination Data for Food Deliveries Food Distribution Program (State and Local Government)	Form and Instruction
Form FNS-52 Food Requisitions WBSCM Screen Shot Food Distribution Program (State and Local Government)	Form
Form FNS-53 Requisition for Multi-Food Shipments WBSCM Screen Shot Food Distribution Program (State and Local Government)	Form
Form FNS-57 Report of Shipments Over, Short, and/or Damaged WBSCM Screen Shot Food Distribution Program (State and Local Government)	Form
Form FNS-152 Monthly Distribution of Donated Food to Family Units Food Distribution Program (State and Local Government)	Form
Form FNS-153 Monthly CSFP Report and Quarterly Administrative Financial Status Food Distribution Program (State and Local Government)	Form and Instruction
Form FNS-155 Inventory Management Register Food Distribution Program (State and Local Government)	Form and Instruction
Form FNS-667 Report of TEFAP Administrative Costs Food Distribution Program (State and Local Government)	Form and Instruction
Attachment 23 - State Plan Amendment Template for FY 2020 Farm to Food Bank Projects.pdf	Other-State Plan Amendment Template
FNS-7 Destination Data for Food Deliveries Attachment 12- FNS-7 Destination Data for Food Deliveries.pdf	Form and Instruction
FNS-52 Food Requisitions WBSCM Screen Shot Attachment 13A FNS-52 WBSCM Screenshots.pptx	Form
FNS-53 Requisition for Multi-Food Shipments WBSCM Screen Shot Attachment 13B FNS-53 WBSCM Screenshots.pptx	Form
FNS-57 Report of Shipments Over, Short, and/or Damaged WBSCM Sc Attachment 13C FNS-57 WBSCM Screenshots.pptx	Form
FNS-152 Monthly Distribution of Donated Food to Family Units Attachment 14- FNS 152 Monthly Distribution of Donated Foods to Family Units.pdf	Form
FNS-153 Monthly CSFP Report and Quarterly Administrative Financi Attachment 15- FNS-153 Monthly CSFP Report and Quarterly Administrative Financial Status.pdf	Form and Instruction
FNS-155 Inventory Management Register Attachment 16- FNS-155 Inventory Management Register.pdf	Form and Instruction
FNS-667 Report of TEFAP Administrative Costs Attachment 17- FNS-667 Report of TEFAP Administrative Costs.pdf	Form and Instruction
Attachment 18- SF-424 Application for Federal Assistance.pdf Attachment 18 - SF-424 Application for Federal Assistance	IC Document
Attachment 19- SF- 425 Federal Financial Report.pdf Attachment 19 - SF-425 Federal Financial Report	IC Document
Attahment 20-A-FNS-152 FPRS Screen Shots.pptm Attachment 20-A FNS-152 Food Programs Reporting System (FPRS) Screen Shot	IC Document
Attahment 20-B FNS-153 FPRS Screen Shots.pptm Attachment 20-B FNS-153 Food Programs Reporting System (FPRS) Screen Shot	IC Document
Attahment 20-C FNS-667 FPRS Screen Shots.pptm Attachment 20-C FNS-667 Food Program Reporting System (FPRS) Screen Shot	IC Document
Attahment 20-D-FNS-44 FPRS Screen Shots.pptm Attachment 20-D FNS-144 Food Program Reporting System (FPRS) Screen Shot	IC Document
Attahment 20-E FNS-10 FPRS Screen Shots.pptm Attachment 20-E FNS-10 Food Program Reporting System (FPRS) Screen Shot	IC Document
Attahment 20-F FNS-191 FPRS Screen Shots.pptm Attachment 20-F FNS-191 Food Program Reporting System (FPRS) Screen Shot	IC Document
Attahment 20-G FNS-292 FPRS Screen Shots.pptm Attachment 20-G FNS-292 Food Program Reporting System (FPRS) Screen Shot	IC Document
Attachment 20-H - FPRS Welcome Page with OMB Disclosure Statement.pdf Attachment 20-H FPRS Welcome Page with OMB Disclosure Statement	IC Document
Attachment 22- WBSCM FAQs and Tips.pdf Attachment 22 WBSCM FAQs and Tips	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Food Distribution Program (State and Local Government)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 7 CFR 240, 247, 250, 251, 253, 254 (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	FNS-7	Yes	No	Fillable Printable
Form	FNS-52	Yes	Yes	Fillable Fileable
Form	FNS-53	Yes	Yes	Fillable Fileable
Form	FNS-57	Yes	Yes	Fillable Fileable
Form	FNS-152	Yes	No	Fillable Printable
Form and Instruction	FNS-153	Yes	No	Fillable Printable
Form and Instruction	FNS-155	Yes	No	Fillable Printable
Form and Instruction	FNS-667	Yes	No	Fillable Printable
Other-State Plan Amendment Template		Yes	No	Fillable Printable

Federal Enterprise Architecture Business Reference Module

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 21,440

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 27 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	703,450	0	703,450
Annual IC Time Burden (Hours)	94,318	225	94,093
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment 18 - SF-424 Application for Federal Assistance		11/26/2019
Attachment 19 - SF-425 Federal Financial Report		11/26/2019
Attachment 20-A FNS-152 Food Programs Reporting System (FPRS) Screen Shot		11/26/2019
Attachment 20-B FNS-153 Food Programs Reporting System (FPRS) Screen Shot		11/26/2019
Attachment 20-C FNS-667 Food Program Reporting System (FPRS) Screen Shot		11/26/2019
Attachment 20-D FNS-144 Food Program Reporting System (FPRS) Screen Shot		11/26/2019
Attachment 20-E FNS-10 Food Program Reporting System (FPRS) Screen Shot		11/26/2019
Attachment 20-F FNS-191 Food Program Reporting System (FPRS) Screen Shot		11/26/2019
Attachment 20-G FNS-292 Food Program Reporting System (FPRS) Screen Shot		11/26/2019
Attachment 20-H FPRS Welcome Page with OMB Disclosure Statement		11/26/2019
Attachment 22 WBSCM FAQs and Tips		11/26/2019

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

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