Information Collection

Individuals

IC 268907 under ICR 202406-0584-003 · OMB 0584-0699.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0699 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment C. Survey Instrument 08072024.docx	Other-Attachment C. Survey Instrumen
Attachment C. Survey Instrument 08072024.docx	Other-Attachment C. Survey Instrumen

IC Title:

Individuals

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

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
Other-Attachment C. Survey Instrument 08072024			Attachment C. Survey Instrument 08072024.docx		Yes	Yes	Fillable Fileable

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 6

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	6	6
Annual IC Time Burden (Hours)	9	9
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.