Information Collection

State, Local, and Tribal Government Non-Respondents

IC 258560 under ICR 202210-0584-002 · OMB 0584-0681.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
NON RESPONDENT PLACE HOLDER (1).docx	Other-NON RESPONDENT PLACE HOLDER (1
NON RESPONDENT PLACE HOLDER (1).docx	Other-NON RESPONDENT PLACE HOLDER (1

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

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
Other-NON RESPONDENT PLACE HOLDER (1)					No		Paper Only

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 4

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	8	8
Annual IC Time Burden (Hours)	1	1
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.

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