Information Collection

OMB# 4040-0014 SF 425 (CN/SNAP/FD/FDPNE/WIC/Pandemic/PAN SLT

IC 204616 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⚠️ Notice: This information collection may be referencing outdated material.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
Form SF 425 (screenshot OMB# 4040-0014 SF 425 (CN/SNAP/FD/FDPNE/WIC/Pandemic/PAN SLT	Form and Instruction
SF-425 and instructions.pdf fprs.fns.usda.gov	Instruction
SF-425 and instructions.pdf fprs.fns.usda.gov	Instruction
CN SF-425.docx fprs.gov	Other-CN Administrative Review & Tra
CN SF-425.docx fprs.gov	Other-CN Administrative Review & Tra
SF 425 (screenshot Federal Financial Report CN-ARTMII_SF-425_Report_1.jpg fprs.fns.usda.gov	Form and Instruction
SF 425 (screenshot Federal Financial Report CN-ARTMII_SF-425_Report_1.jpg fprs.fns.usda.gov	Form and Instruction
SF 425 (screenshot Federal Financial Report CN-ARTMII_SF-425_Report_2.jpg www.fprs.gov	Form and Instruction
SF 425 (screenshot Federal Financial Report CN-ARTMII_SF-425_Report_2.jpg www.fprs.gov	Form and Instruction
SF 425 Screenshots Federal Financial Report CN-ARTMII_SF-425_Remarks.jpg www.fprs.gov	Form and Instruction
SF 425 Screenshots Federal Financial Report CN-ARTMII_SF-425_Remarks.jpg www.fprs.gov	Form and Instruction

IC Title:

OMB# 4040-0014 SF 425 (CN/SNAP/FD/FDPNE/WIC/Pandemic/PAN SLT

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

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 and Instruction	SF 425 (screenshot page 1)	Federal Financial Report	CN-ARTMII_SF-425_Report_1.jpg	https://fprs.fns.usda.gov	Yes	Yes	Fillable Fileable Signable
Instruction			SF-425 and instructions.pdf	https://fprs.fns.usda.gov	Yes	Yes	Fillable Fileable Signable
Form and Instruction	SF 425 (screenshot page 2)	Federal Financial Report	CN-ARTMII_SF-425_Report_2.jpg	www.fprs.gov	Yes	Yes	Fillable Fileable Signable
Form and Instruction	SF 425 Screenshots (remarks section)	Federal Financial Report	CN-ARTMII_SF-425_Remarks.jpg	www.fprs.gov	Yes	Yes	Fillable Fileable Signable
Other-CN Administrative Review & Training			CN SF-425.docx	https://fprs.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: 150

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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	6,050	-1,889	-2,416	10,355
Annual IC Time Burden (Hours)	22,351	10,442	-3,624	15,533
Annual IC Cost Burden (Dollars)	0	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.