Information Collection

SNAP, WIC, FMNP, and CN COVID-19 Waivers, Evaluation, and Reporting Data - State Agencies and WIC Local Government (SLT)

IC 241637 under ICR 202004-0584-004 · OMB 0584-0654.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0654 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment C Example FFCRA SNAP Waiver Request Template.docx	Other-Attachment C Example FFCRA SNA
Attachment D Example WIC Waiver Request Template.pdf	Other-Attachment D Example WIC Waive
Attachment E Example FMNP Waiver Request Template.pdf	Other-Attachment E Example FMNP Waiv
Attachment H FNS292A.pdf Attachment H FNS 292A	IC Document
Attachment I FNS-418.pdf Attachment I FNS 418	IC Document
Attachment J FNS-10.pdf Attachment J FNS10	IC Document
Attachment K FNS-44.pdf Attachment K FNS 44	IC Document

IC Title:

SNAP, WIC, FMNP, and CN COVID-19 Waivers, Evaluation, and Reporting Data - State Agencies and WIC Local Government (SLT)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Attachment C Example FFCRA SNAP Waiver Request Template	Attachment C Example FFCRA SNAP Waiver Request Template.docx	No		Paper Only
Other-Attachment D Example WIC Waiver Request Template	Attachment D Example WIC Waiver Request Template.pdf	Yes	Yes	Fillable Fileable
Other-Attachment E Example FMNP Waiver Request Template	Attachment E Example FMNP Waiver Request Template.pdf	No		Fillable Printable

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,068

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 62 %

table that charts list of burden
	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	5,994	5,994
Annual IC Time Burden (Hours)	6,996	6,996
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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