Information Collection

State Agencies

IC 244868 under ICR 202103-0584-003 · OMB 0584-0660.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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.