Information Collection

Worksheet FNS 191 (OMB# 0025)

IC 260590 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⚠️ Notice: This information collection may be referencing outdated material.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-191 Instructions.pdf fprs.usda.fns.gov	Instruction
FNS-191 Instructions.pdf fprs.usda.fns.gov	Instruction
FNS-191.docx fprs.usda.fns.gov	Other-FNS 191 Screenshot CSFP Racial
FNS-191.docx fprs.usda.fns.gov	Other-FNS 191 Screenshot CSFP Racial

IC Title:

Worksheet FNS 191 (OMB# 0025)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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
Instruction			FNS-191 Instructions.pdf	https://fprs.usda.fns.gov	Yes	Yes	Fillable Fileable Signable
Other-FNS 191 Screenshot CSFP Racial/Ethnic Group Participation			FNS-191.docx	https://fprs.usda.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: 252

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
Annual Number of Responses for this IC	252	252
Annual IC Time Burden (Hours)	504	504
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.