Business

Food Distribution Programs

Documents and Forms

Document Name Document Type
Form FNS-57 Business Form
FNS-57 FNS Shipment Receipt Appendix W - WBSCM Resources for Customer Organizations.docx Form
FNS-57 FNS Shipment Receipt Appendix W - WBSCM Resources for Customer Organizations.docx Form
Appendix R - SF-424 Application for Federal Assistance.pdf Appendix R - SF-424 Application for Federal Assistance IC Document
Appendix R - SF-424 Application for Federal Assistance.pdf Appendix R - SF-424 Application for Federal Assistance IC Document
Appendix S - SF- 425 Federal Financial Report.pdf Appendix S - SF- 425 Federal Financial Report IC Document
Appendix S - SF- 425 Federal Financial Report.pdf Appendix S - SF- 425 Federal Financial Report IC Document

Information Collection (IC) Details

IC Title:	Business	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 7 CFR 250.69(c),(d) 7 CFR 250.70(c),(d) 7 CFR 251.2(c)(2) 7 CFR 250.35(d) 7 CFR 250.4(b) and (c) 7 CFR 247.30(d)(3) 7 CFR 250.30(c)(1) 7 CFR 251.10(a)(1), (a)(2), (a)(3) 7 CFR 250.37(a), (c), and (d) 7 CFR 250.14(b) and (d) 7 CFR 247.28(b) 7 CFR 250.34 7 CFR 250.33(a) 7 CFR 250.19(a) 7 CFR 250.30 (c), (d), (e), (f)(i) 7 CFR 250.58(a) 7 CFR 250.20(c) 7 CFR 250.10(a) 7 CFR 250.15(b) and (c) 7 CFR 250.11(b) 7 CFR 250.17(c) 7 CFR 240.4 7 CFR 250.12(f) 7 CFR 250.18 (b)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	FNS-57	FNS Shipment Receipt	Appendix W - WBSCM Resources for Customer Organizations.docx		Yes	Yes	Fillable Printable

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4,283	Number of Respondents for Small Entity: 44

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 27 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,912,132	-1,609	1,913,741
Annual IC Time Burden (Hours)	762,043	-616	762,659
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Appendix R - SF-424 Application for Federal Assistance	Appendix R - SF-424 Application for Federal Assistance.pdf	07/06/2023
Appendix S - SF- 425 Federal Financial Report	Appendix S - SF- 425 Federal Financial Report.pdf	07/06/2023

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