State Agencies

Pandemic Electronic Benefit Transfer (P-EBT)

Documents and Forms

Document Name Document Type
Attachment C FNS-292B.pdf Attachment C FNS 292 IC Document
Attachment C FNS-292B.pdf Attachment C FNS 292 IC Document
Attachment F SF-425.pdf Attachment F SF 425 IC Document
Attachment F SF-425.pdf Attachment F SF 425 IC Document

Information Collection (IC) Details

IC Title:	State Agencies	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 7 CFR 245.6 (f) (2)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records
Title: USDA/FNS-10: Persons Doing Business with the Food and Nutrition Service	FR Citation: 65 FR 17251

Number of Respondents: 50	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 Agency Discretion	Previously Approved
Annual Number of Responses for this IC	50	-8,661,010	8,661,060
Annual IC Time Burden (Hours)	800	-8,661,029	8,661,829
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment C FNS 292	Attachment C FNS-292B.pdf	11/06/2023
Attachment F SF 425	Attachment F SF-425.pdf	11/06/2023

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