Information Collection

Worksheet FNS 13 OMB#0075

IC 203831 under ICR 202204-0584-003 · OMB 0584-0594.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0594 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form FNS 13 Worksheet FNS 13 OMB#0075	Form and Instruction
FNS-13.pdf fprs.fns.usda.gov	Instruction
FNS-13.pdf fprs.fns.usda.gov	Instruction
FNS 13 Annual Report of State Revenue Matching CN-FNS-13.jpg fprs.fns.usda.gov	Form and Instruction
FNS 13 Annual Report of State Revenue Matching CN-FNS-13.jpg fprs.fns.usda.gov	Form and Instruction

IC Title:

Worksheet FNS 13 OMB#0075

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Mandatory

CFR Citation: 7 CFR 210.17

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 and Instruction	FNS 13	Annual Report of State Revenue Matching	CN-FNS-13.jpg	https://fprs.fns.usda.gov	Yes	Yes	Fillable Fileable Signable
Instruction			FNS-13.pdf	https://fprs.fns.usda.gov	Yes	Yes	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 57

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	Previously Approved
Annual Number of Responses for this IC	57	57
Annual IC Time Burden (Hours)	114	114
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.