Information Collection

Worksheet 366B OMB# 0083

IC 237913 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⚠️ Notice: This information collection may be referencing outdated material.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 366 B Worksheet 366B OMB# 0083	Form and Instruction
FNS 366b.pdf fprs.fns.usda.gov	Instruction
FNS 366b.pdf fprs.fns.usda.gov	Instruction
ATTACHMENT 7_FNS-366B Mockup Form InstructionsPDF.docx www.fprs.fns.gov	Instruction
ATTACHMENT 7_FNS-366B Mockup Form InstructionsPDF.docx www.fprs.fns.gov	Instruction
FNS 366 B Program and Budget Summary Statement FNS-366B.docx fprs.fns.usda.gov	Form and Instruction
FNS 366 B Program and Budget Summary Statement FNS-366B.docx fprs.fns.usda.gov	Form and Instruction
FNS 366B Form Chan PROGRAM AND BUDGET SUMMARY STATEMENT PART B - PROGRAM AC ATTACHMENT 8_Proposed 366B Form Changes_20210922.xlsx www.fprs.fns.gov	Form
FNS 366B Form Chan PROGRAM AND BUDGET SUMMARY STATEMENT PART B - PROGRAM AC ATTACHMENT 8_Proposed 366B Form Changes_20210922.xlsx www.fprs.fns.gov	Form
ATTACHMENT 3_ FPRS Home Page Screenshot w-Public Burden Statement expired 7-2023 home page.pdf ATTACHMENT 3_ FPRS Home Page Screenshot w-Public Burden Statement expired 7-2023 home page.pdf	IC Document
ATTACHMENT 3_ FPRS Home Page Screenshot w-Public Burden Statement expired 7-2023 home page.pdf ATTACHMENT 3_ FPRS Home Page Screenshot w-Public Burden Statement expired 7-2023 home page.pdf	IC Document

IC Title:

Worksheet 366B OMB# 0083

Agency IC Tracking Number:

Changed due to AE68 burden remains unchanged

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 7 CFR 272.2

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 366 B	Program and Budget Summary Statement	FNS-366B.docx	https://fprs.fns.usda.gov	Yes	Yes	Fillable Fileable Signable
Instruction			FNS 366b.pdf	https://fprs.fns.usda.gov	Yes	Yes	Fillable Fileable Signable
Instruction			ATTACHMENT 7_FNS-366B Mockup Form InstructionsPDF.docx	https://www.fprs.fns.gov	Yes	Yes	Fillable Fileable Signable
Form	FNS 366B Form Changes due to AE 68	PROGRAM AND BUDGET SUMMARY STATEMENT PART B - PROGRAM ACTIVITY STATEMENT	ATTACHMENT 8_Proposed 366B Form Changes_20210922.xlsx	https://www.fprs.fns.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: 53

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	212	212
Annual IC Time Burden (Hours)	3,180	3,180
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
ATTACHMENT 3_ FPRS Home Page Screenshot w-Public Burden Statement expired 7-2023 home page.pdf	ATTACHMENT 3_ FPRS Home Page Screenshot w-Public Burden Statement expired 7-2023 home page.pdf	05/02/2022

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.