Information Collection

Individuals/Households

IC 259304 under ICR 202303-0584-002 · OMB 0584-0686.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form FNS 775 Individuals/Households	Form
Appendix E EmpowHr Screenshots.docx	Other-EmpowHR Person Model - 775 Scr
Appendix E EmpowHr Screenshots.docx	Other-EmpowHR Person Model - 775 Scr
FNS 775 EmpowHR Person Model Appendix B FNS 775 EmpowHR Person Model.pdf	Form
FNS 775 EmpowHR Person Model Appendix B FNS 775 EmpowHR Person Model.pdf	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

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	FNS 775	EmpowHR Person Model	Appendix B FNS 775 EmpowHR Person Model.pdf		No		Paper Only
Other-EmpowHR Person Model - 775 Screenshots			Appendix E EmpowHr Screenshots.docx	www.currently-under-development.gov	Yes	Yes	Fillable Fileable Signable

Line of Business: Homeland Security

Subfunction: Key Asset and Critical Infrastructure Protection

Privacy Act System of Records

Title: USDA/OP-1 Personnel and Payroll System

FR Citation: 63 FR 4213

Number of Respondents: 62

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	62	62
Annual IC Time Burden (Hours)	31	31
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.