Information Collection

Worksheet FNS 10 OMB# 0002

IC 203829 under ICR 202303-0584-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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
FNS-10.pdf fprs.fns.usda.gov	Instruction
FNS-10.pdf fprs.fns.usda.gov	Instruction
FNS-10 Form (Non-Congregate) v1 (IMB).pdf fprs.fns.usda.gov	Other-FNS-10 Form (Non-Congregate) v
FNS-10 Form (Non-Congregate) v1 (IMB).pdf fprs.fns.usda.gov	Other-FNS-10 Form (Non-Congregate) v
FNS-10 SSO Form (Non-Congregate) v2.docx fprs.fns.usda.gov	Other-FNS-10 SSO Form (Non-Congregat
FNS-10 SSO Form (Non-Congregate) v2.docx fprs.fns.usda.gov	Other-FNS-10 SSO Form (Non-Congregat

IC Title:

Worksheet FNS 10 OMB# 0002

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 7 CFR 210.5

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction	FNS-10.pdf	https://fprs.fns.usda.gov	Yes	Yes	Fillable Fileable Signable
Other-FNS-10 Form (Non-Congregate) v1 (IMB)	FNS-10 Form (Non-Congregate) v1 (IMB).pdf	https://fprs.fns.usda.gov	Yes	Yes	Fillable Fileable Signable
Other-FNS-10 SSO Form (Non-Congregate) v2	FNS-10 SSO Form (Non-Congregate) v2.docx	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	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	2,052	684	1,368
Annual IC Time Burden (Hours)	3,591	855	2,736
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.