Information Collection

State and Local Government

IC 249773 under ICR 202110-0584-003 · OMB 0584-0670.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appendix D. Survey support email.docx	Other-Appendix D. Survey support ema
Appendix D. Survey support email.docx	Other-Appendix D. Survey support ema
Appendix B. SFA Survey on Supply Chain Disruption.docx	Other-Appendix B. SFA Survey on Supp
Appendix C. SFA Contact Information Request.docx	Other-Appendix C. SFA Contact Inform
Appendix C. SFA Contact Information Request.docx	Other-Appendix C. SFA Contact Inform
Appendix B. SFA Survey on Supply Chain Disruption FINAL.docx	Other-Appendix B. SFA Survey on Supp
Appendix E. Reminder Email.docx Appendix E. Reminder Email	IC Document
Appendix E. Reminder Email.docx Appendix E. Reminder Email	IC Document
Appendix F. Thank you email.docx Appendix F. Thank you email	IC Document
Appendix F. Thank you email.docx Appendix F. Thank you email	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Appendix D. Survey support email	Appendix D. Survey support email.docx	Yes	Yes	Fillable Fileable
Other-Appendix C. SFA Contact Information Request	Appendix C. SFA Contact Information Request.docx	Yes	Yes	Fillable Fileable
Other-Appendix B. SFA Survey on Supply Chain Disruption FINAL	Appendix B. SFA Survey on Supply Chain Disruption FINAL.docx	Yes	Yes	Fillable Fileable

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 15,705

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 20 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	78,366	78,366
Annual IC Time Burden (Hours)	7,293	7,293
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Appendix E. Reminder Email	Appendix E. Reminder Email.docx	10/15/2021
Appendix F. Thank you email	Appendix F. Thank you email.docx	10/20/2021

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