Information Collection

Worksheet FNS 209 & FNS 209 PR OMB# 0069 (53 States plus 1 Puerto Rico = 54 State agencies)

IC 204659 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⚠️ Notice: This information collection may be referencing outdated material.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 FNS 209 Screenshot Worksheet FNS 209 & FNS 209 PR OMB# 0069 (53 States plus 1 Puerto Rico = 54 State agencies)	Form and Instruction
Form FNS 209 Screenshot Status of Claims Against Households Worksheet FNS 209 & FNS 209 PR OMB# 0069 (53 States plus 1 Puerto Rico = 54 State agencies)	Form and Instruction
Form FNS 209 Screenshot Status of Claims Against Households Worksheet FNS 209 & FNS 209 PR OMB# 0069 (53 States plus 1 Puerto Rico = 54 State agencies)	Form and Instruction
FNS 209.pdf fprs.fns.usda.gov	Instruction
FNS 209.pdf fprs.fns.usda.gov	Instruction
FNS 209 Screenshot Status of Claims Against Households FNS-209.docx	Form and Instruction
FNS 209 Screenshot Status of Claims Against Households FNS-209.docx	Form and Instruction
FNS 209 Screenshot Status of Claims Against Households FNS-209 PR.docx fprs.fns.usda.gov	Form and Instruction
FNS 209 Screenshot Status of Claims Against Households FNS-209 PR.docx fprs.fns.usda.gov	Form and Instruction

IC Title:

Worksheet FNS 209 & FNS 209 PR OMB# 0069 (53 States plus 1 Puerto Rico = 54 State agencies)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 7 CFR 273.18

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 209 Screenshot	Status of Claims Against Households	FNS-209.docx	https:/fprs.fns.usda.gov	Yes	Yes	Fillable Fileable Signable
Form and Instruction	FNS 209 Screenshot Puerto Rico (PR)	Status of Claims Against Households	FNS-209 PR.docx	https://fprs.fns.usda.gov	Yes	Yes	Fillable Fileable Signable
Instruction			FNS 209.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: 54

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	216	216
Annual IC Time Burden (Hours)	648	648
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.