Information Collection

State Agencies

IC 246994 under ICR 202104-0584-001 · OMB 0584-0667.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
2021-05-04 Appendix D-9 FNS-908.pdf	Other- Appendix D-9 FNS-908
2021-05-04 Appendix D-9 FNS-908.pdf	Other- Appendix D-9 FNS-908
Appendix B Announcement Letter.docx	Other-Appendix B Announcement Letter
Appendix C Template.docx	Other-Appendix C Template
Appendix C Template.docx	Other-Appendix C Template
June 23 2021 Appendix B Announcement Letter.docx	Other-Appendix B Announcement Letter

IC Title:

State Agencies

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 7 CFR 235

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other- Appendix D-9 FNS-908	2021-05-04 Appendix D-9 FNS-908.pdf	Yes	Yes	Fillable Fileable
Other-Appendix C Template	Appendix C Template.docx	Yes	Yes	Fillable Fileable
Other-Appendix B Announcement Letter	June 23 2021 Appendix B Announcement Letter.docx	No		Paper Only

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 60

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
Annual Number of Responses for this IC	1,020	1,020
Annual IC Time Burden (Hours)	1,508	1,508
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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