Information Collection

SNAP Agency Matching Program Performance Reporting Tool and Instructions

IC 217786 under ICR 202111-0970-005 · OMB 0970-0464.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0464 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 SNAP Agency Matching Program Performance Reporting Tool and Instructions	Form
0970-0464_State_SNAP_Agency_NDNH_Matching_Program_Performance_Reporting_Instructions.docx	Instruction
0970-0464_State_SNAP_Agency_NDNH_Matching_Program_Performance_Reporting_Instructions.docx	Instruction
1 SNAP-Agency NDNH Match Results Performance Reporting Too 0970-0464_State SNAP_Agency_NDNH_Matching_Program_Performance_Reporting_Tool.xls	Form
1 SNAP-Agency NDNH Match Results Performance Reporting Too 0970-0464_State SNAP_Agency_NDNH_Matching_Program_Performance_Reporting_Tool.xls	Form

IC Title:

SNAP Agency Matching Program Performance Reporting Tool and Instructions

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
Form	1	SNAP-Agency NDNH Match Results Performance Reporting Tool	0970-0464_State SNAP_Agency_NDNH_Matching_Program_Performance_Reporting_Tool.xls		Yes	Yes	Fillable Printable
Instruction			0970-0464_State_SNAP_Agency_NDNH_Matching_Program_Performance_Reporting_Instructions.docx		Yes	Yes	Fillable Printable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

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	Previously Approved
Annual Number of Responses for this IC	53	0	53
Annual IC Time Burden (Hours)	44	-58	102
Annual IC Cost Burden (Dollars)	0	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.