State Agencies

Pandemic Electronic Benefit Transfer (P-EBT)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0660 can be found here:

Documents and Forms

Document Name Document Type
Attachment C P-EBT State Plan Template School Year 2020-2021.pdf Other-Attachment C P-EBT State Plan
Attachment C P-EBT State Plan Template School Year 2020-2021.pdf Other-Attachment C P-EBT State Plan
Attachment D P-EBT State Plan Template Summer 2021.pdf Other-Attachment D P-EBT State Plan
Attachment D P-EBT State Plan Template Summer 2021.pdf Other-Attachment D P-EBT State Plan
Attachment E FNS-292B.pdf Attachment E FNS-292B IC Document
Attachment E FNS-292B.pdf Attachment E FNS-292B IC Document
Attachment F FNS-388.pdf Attachment F FNS-388 IC Document
Attachment F FNS-388.pdf Attachment F FNS-388 IC Document
Attachment G FNS-46.jpg Attachment G FNS-46 IC Document
Attachment G FNS-46.jpg Attachment G FNS-46 IC Document
Attachment H FNS-366A.pdf Attachment H FNS-366A IC Document
Attachment H FNS-366A.pdf Attachment H FNS-366A IC Document
Attachment I SF-425.pdf Attachment I SF-425 IC Document
Attachment I SF-425.pdf Attachment I SF-425 IC Document

Information Collection (IC) Details

IC Title:	State Agencies	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Attachment C P-EBT State Plan Template School Year 2020-2021			Attachment C P-EBT State Plan Template School Year 2020-2021.pdf		Yes	No	Printable Only
Other-Attachment D P-EBT State Plan Template Summer 2021			Attachment D P-EBT State Plan Template Summer 2021.pdf		Yes	No	Printable Only

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records
Title: USDA/FNS-10: Persons Doing Business with the Food and Nutrition Service	FR Citation: 65 FR 17251

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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	8,661,060	0	7,000,106	1,660,954
Annual IC Time Burden (Hours)	8,661,829	80	8,245,318	416,431
Annual IC Cost Burden (Dollars)	0	0	0	0

Documents for IC

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