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State Agencies
Child and Adult Care Food Program (CACFP) National Disqualified List
OMB: 0584-0584
IC ID: 206841
OMB.report
USDA/FNS
OMB 0584-0584
ICR 202307-0584-006
IC 206841
( )
Documents and Forms
Document Name
Document Type
Form FNS-844
State Agencies
Form
FNS-844 Report of Disqualification from Participation - Individu
A-2 FNS-844 Report of Disqualification from Participation – Individually Disqualified Responsible Principal Individual or Day Ca
Form
FNS-844 Report of Disqualification from Participation - Individu
A-2 FNS-844 Report of Disqualification from Participation – Individually Disqualified Responsible Principal Individual or Day Ca
Form
FNS-843 Report of Disqualification from Participation: Instituti
A-1 FNS-843 Report of Disqualification from Participation .pdf
Form and Instruction
FNS-843 Report of Disqualification from Participation: Instituti
A-1 FNS-843 Report of Disqualification from Participation .pdf
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
State Agencies
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Mandatory
CFR Citation:
7 CFR 226.6(c)(7)(i)
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
FNS-844
Report of Disqualification from Participation - Individually Disqualified Responsible Principal/Individual or Day Care Home Provider
A-2 FNS-844 Report of Disqualification from Participation – Individually Disqualified Responsible Principal Individual or Day Care Home Provider.pdf
Yes
Yes
Fillable Fileable
Form and Instruction
FNS-843
Report of Disqualification from Participation: Institution and Responsible Principals/Individuals
A-1 FNS-843 Report of Disqualification from Participation .pdf
Yes
Yes
Fillable Printable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Income Security
Subfunction:
Food and Nutrition Assistance
Privacy Act System of Records
Title:
USDA/FNS-11 Information on Persons Identified as Responsible for Serious Deficiencies, Proposed for Disqualification, or Disqualified to Participate as Principals or Family Day Care Home Operators in
FR Citation:
69 FR 6933
Number of Respondents:
56
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
100 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
1,568
0
0
0
0
1,568
Annual IC Time Burden (Hours)
784
0
0
0
0
784
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
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.