FNS-380, Worksheet for the Supplemental Nutrition Assistance Program Quality Control Reviews

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
I. Excel Chart for AE64, 0584-0074 FNS 380 Burden Table 4-12-22.xlsx	Supplementary Document	Uploaded 2022-05-12	Available
H. Burden Narrative 0584-0074 FNS 380 4-30-21cln PRAO comments 6-23-2021cln.docx	Supplementary Document	Uploaded 2021-06-25	Available
G. FNS-5 REV FNS–5 Info on Persons Disqual from SNAP.pdf	Supplementary Document	Uploaded 2021-06-25	Available
D. AgImpAct2018-QC provisions.pdf	Supplementary Document	Uploaded 2021-06-25	Available
C. fna-2008-amended-through-pl-116-94 pgs 105-111.pdf	Supplementary Document	Uploaded 2021-06-25	Available
OMB 0584-0074 FNS 380 SS Part A 4-21-22 clean.docx	Supporting Statement A	Uploaded 2022-05-12	Available
OMB 0584-0074 FNS 380 SS Part B 2021 cln.docx	Supporting Statement B	Uploaded 2021-06-24	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
45873	SNAP Quality Control Review - Household Burden Personal Interviews		Modified
2971	SNAP Quality Control Reviews - State Burden	Form and Instruction	Modified

ICR Details

OMB Control No: 0584-0074	ICR Reference No: 202106-0584-001
Status: Received in OIRA	Previous ICR Reference No: 201904-0584-003
Agency/Subagency: USDA/FNS	Agency Tracking No: RIN 0584-AE64 (Interim Final Rule)
Title: FNS-380, Worksheet for the Supplemental Nutrition Assistance Program Quality Control Reviews
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 06/07/2022

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved	04/30/2023
Responses	318,483	318,478
Time Burden (Hours)	405,996	405,996
Cost Burden (Dollars)	0	0

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Abstract: This form provides a systematic means of aiding the State's Quality Control Reviewer in analyzing the case record, planning and doing field investigation and gathering, comparing, analyzing and evaluating data.

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Authorizing Statute(s): PL: Pub.L. 108 - 269 16 Name of Law: Food Stamp Act of 1977
  

Citations for New Statutory Requirements: PL: Pub.L. 116 - 94 4013 Name of Law: Agricultural Improvement Act 2018

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0584-AE64	Final or interim final rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 44575	08/12/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 34233	06/06/2022
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
SNAP Quality Control Review - Household Burden Personal Interviews
SNAP Quality Control Reviews - State Burden	FNS 380, FNS 380	Screenshots for FNS 380 Worksheet for Quality Control Reviews ,   FNS 380 Worksheet for Quality Control Reviews

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ICR Summary of Burden

table that charts list of burden

	Total Request	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	318,483	318,478	5	0	0	0
Annual Time Burden (Hours)	405,996	405,996	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $12,773,129

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 06/07/2022

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