Appendix Z FNS 83I FDP ICR

UNITED STATES DEPARTMENT OF AGRICULTURE

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Food and Nutrition Service

PAPERWORK REDUCTION ACT SUBMISSION (83-I)
Please read the instructions before completing this form. For assistance in completing this form, contact Planning & Regulatory Affairs Office. Send a
signed copy of this form, the collection instruments to be reviewed, the Supporting Statement, and any additional documentation to: PRAO, Office of
Policy Support, Room 1014 or via email at: [email protected].
1. Agency originating request

2. OMB control number
a. 0584 - 0401
b. 0584-NEW
4. Type of review requested (check one)

USDA-FNS

3. Type of information collection (check one)
a.
b.
c.
d.

New collection
Revision of a currently approved collection
Extension of a currently approved collection

a.
b.
c.

Reinstatement, without change, of a previously approved
collection for which approval has expired

5. Small entities

e.

Reinstatement, with change, of a previously approved
collection for which approval has expired

a.
b.

f.

Existing collection in use without an OMB control number

6. Requested expiration date

Regular submission - Approval requested by:
Emergency - Approval requested by:
Delegated

Percentage of respondents that are small entities:
Will this information collection have a significant
economic impact on a substantial number of small
entities?
7. Title

%
Yes

No

Food Delivery Portal (FDP) Data Collection

Three years from b.
Other - Specify:
approval date
8. Agency form number(s) (if applicable)
a.

9. Authorizing Statute (Public Law, Statute at Large, or Executive Order)

Food Delivery Portal (FDP) Data Collection
10. Abstract

To appropriately monitor and evaluate WIC State agencies' oversight of food delivery entities to prevent, detect, and eliminate fraud,
waste, and abuse
11. Affected public (Mark primary with "P" and all others that apply with "X")
a.
b.
c.

Individuals or household
d.
Business or other for-profit e.
Not-for-profit institutions
f.

P

Farms
Federal Government
State, Local or Tribal Govt.

13. Annual reporting and recordkeeping hour burden
a. Number of respondents
b. Total annual responses
1. Percentage of these responses
collected electronically
c. Total annual hours requested
d. Current OMB inventory
e. Difference
f. Explanation of difference
1. Program change
2. Adjustment

12. Obligation to respond (Mark primary with "P" and all others that apply
with "X")
Voluntary
Required to obtain or retain benefits
Mandatory

P

14. Frequency of recordkeeping or reporting (check all that apply)

89
541

100.00 %
3,576
1,189
2,387
-30
2,416
2,387

Recordkeeping
Reporting
a.
d.
g.

On occasion
Quarterly
Biennially

Third party disclosure
b.
e.
h.

Weekly
Semi-annually
Other (describe)

c.
f.

Monthly
Annually

16. Statistical methods
Does this information collection employ statistical
methods?

Yes

No

15. Purpose of information collection (Mark primary with "P" and all others
that apply with "X")
Program planning or
a.
Application for benefits
e. P
management
P
b.
Program evaluation
X Research
f.
c. X General purpose statistics
g. P
Regulatory or compliance
d. X Audit

17. Agency contact (person who can best answer questions regarding
the content of this submission)

18. Does this ICR request any personally identifiable information (see OMB
Circular No. A-130 for an explanation of this term)?

19. Does this ICR include a form that requires a Privacy Act Statement
(see 5 U.S.C. §552a(e)(3))?

Yes

No

Name:

Patricia Bailey

Phone:

703-305-2435

Yes

No

20. Is this ICR an EO 13771 deregulatory action (as defined by M-17-21)?
Yes

No

Form FNS-866 (9-17) Previous Editions Obsolete

SBU

Electronic Form Version Designed in Adobe 10.0 Version

21. Certification for Paperwork Reduction Act Submissions
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5CFR 1320.9.
NOTE: The text of 5CFR 1320.9, and the related provisions of 5CFR 1320.8 (b) (3), appear at the end of the instructions.
The certification is to be made with reference to those regulatory provisions as set forth in the instructions.
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(a) It is necessary for the proper performance of agency functions:
(b) It avoids unnecessary duplication;
(c) It reduces burden on small entitles;
(d) It uses plain, coherent, and unambiguous terminology that is understandable to respondents;
(e) Its implementation will be consistent and comparable with current reporting and recordkeeping practices;
(f) It indicates the retention periods for recordkeeping requirements;
(g) It informs respondents of the information called for under 5 CFR 1320.8 (b) (3);
(i)

Why the information being collected;

(ii)

Use of information;

(iii)

Burden estimate;

(iv)

Nature of response (voluntary, required for a benefit, or mandatory);

(v)

Nature and extent of confidentiality; and

(vi)

Need to display currently valid OMB control number.

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use
of the information to be collected.
(i) It uses effective and efficient statistical survey methodology; and
(j) It makes appropriate use of information technology.
If you are unable to certify compliance with any of these provisions, identify the item below and explain the reason in item 18 of the
Supporting Statement.

SIGNATURE OF SENIOR PROGRAM OFFICIAL

SARAH WIDOR

Digitally signed by SARAH WIDOR
Date: 2024.08.19 15:54:42 -04'00'

DATE

INITIAL OF PRAO OFFICIAL

SIGNATURE OF SENIOR OFFICIAL OR DESIGNEE (Optional)

DATE

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DATE

Instructions
7. Title
Provide the official title of the information collection. If an official title does
not exist, provide a description which will distinguish this collection from
others.

Please answer all questions and have the Senior Official or designee sign
the form. These instructions should be used in conjunction with 5 CFR
1320, which provides information on coverage, definitions, and other
matters of procedure and interpretation under the Paperwork Reduction
Act of 1995.

8. Agency form number(s) (if applicable)
Provide any form number the agency has assigned to this collection of
information. Separate each form number with a comma.

1. Agency/Subagency originating request
Provide the name of the agency or subagency originating the request:
FNS or CNPP.

9. Authorizing Statute
Provide the statute that is the source of the ICR or the source of the
associated rule making, whichever is more appropriate. If neither is
appropriate, provide the authorizing statute for the program or for the
agency. Cite a Public Law, Statute at Large, or Executive Order.

2. OMB control number
a. If the information collection in this request has previously received or
now has an OMB control or comment number, enter the control number.
b. Check "New" if the information collection in this request has not
previously received an OMB control number.

10. Abstract
Provide a statement, limited to 4,000 characters, covering the agency's
need for the information, uses to which it will be put, and a brief
description of the respondents.

3. Type of information collection (check one)
a. Check "New Collection" when the collection has not been previously
used or sponsored by the agency.

11. Affected Public
Mark all categories that apply, denoting the primary obligation with a "P"
and all others that apply with "X".

b. Check "Revision" when the collection is currently approved by OMB,
and the agency request includes a material change to the collection
instrument, instructions, its frequency of collection, or the use to which
the information is to be put.

12. Obligation to respond
Mark all categories that apply, denoting the primary obligation with a "P"
and all others that apply with "X".

c. Check "Extension" when the collection is currently approved by OMB,
and the agency wishes only to extend the approval past the current
expiration date without making any material change in the collection
instrument instructions, frequency of collection, or the use to which the
information is to be put.

a. Mark "voluntary" when the response is entirety discretionary and has no
direct effect on any benefit or privilege for the respondent.

d. Check "Reinstatement without change" when the collection previously
had OMB approval, but the approval has expired or was withdrawn
before this submission was made, and there is no change to the
collection.

b. Mark "Required to obtain or retain benefits" when the response is
elective, but is required to obtain or retain a benefit.
c. Mark "Mandatory" when the respondent must reply or face civil or
criminal sanctions.

e. Check "Reinstatement with change" when the collection previously had
OMB approval, but the approval has expired or was withdrawn before
this submission was made, and there is a change to the collection.

13. Annual reporting and recordkeeping hour burden.
a. Enter the number of respondents and/or recordkeepers. If a
respondent is also a recordkeeper, report the respondent only once.

f. Check "Existing collection in use without OMB control number" when the
collection is currently in use but does not have a currently valid OMB
control number.

b. Enter the number of responses provided annually.
b1. Enter the estimated percentage of responses collected electronically
such as via web forms or Computer Assisted Telephone Interview
(CATI).

4. Type of review requested (check one)
a. Check "Regular" when the collection is submitted under 5 CFR
1320.10, 1320.11, or 1320.12, with a standard 60 day review schedule.
Provide the date by which the agency requests OMB approval.

c. Enter the total annual recordkeeping and reporting hour burden.
d. Enter the burden hours currently approved by OMB for this collection
of information. Enter zero (0) for any new submission or for any
collection whose OMB approval has expired.

b. Check "Emergency" when the agency is submitting the request under 5
CFR 1320.13 for emergency processing and provides the required
supporting material. Provide the date by which the agency requests
OMB approval.

e. Enter the difference by subtracting line d from line c. Record a
negative number (d larger than c) within parentheses.

c. Check "Delegated" when the agency is submitting the collection under
the conditions OMB has granted the agency delegated authority.

f. Explain the difference. The difference in line e must be accounted for
in lines f1 and f2.

5. Small entities
Indicate whether this information collection will have a significant impact
on a substantial number of small entities. A small entity may be:

f1. "Program change" is the result of deliberate Federal government
action. All new collections (e.g. the addition or deletion of questions)
are recorded as program changes.

(1) a small business which is deemed to be one that is independently
owned and operated and that is not dominant in its field of operations;

f2. "Adjustment" is a change that is not the result of a deliberate Federal
government action. Changes resulting from new estimates or actions
not controllable by the Federal government are recorded as
adjustments.

(2) a small organization that is any not-for-profit enterprise that is
independently owned and operated and is not dominant in its field; or
(3) a small government jurisdiction which is a government of a city, county,
town, township, school district, or special district with a population of
less than 50,000.
6. Requested expiration date
a. Check "Three years" if the agency requests a three year approval for
the collection.
b. Check "Other" if the agency requests approval for less than three years.
Specify the month and year of the requested expiration date.
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Instructions (Continued)
14. Frequency of recordkeeping or reporting
Multiple choices are acceptable. Select all applicable burden types:
Reporting, Recordkeeping and/or Public Disclosure. If the frequency is on
"an event" basis select "On occasion."
15. Purpose of Information collection
Select all the apply.
16. Statistical methods
Select "Yes" for statistical collections, most research collections, and
program evaluations using sampling imputation or other statistical
estimation techniques. If "Yes" is selected, ensure that Supporting
Statement Part B is submitted.
17. Agency Contact
Provide the name and telephone number of the agency person best able
to answer questions regarding the content of this submission.
18. For assistance in determining if PII is requested, please contact the
FNS Privacy Officer in the Information Management Branch.
19. For assistance in determining if Privacy Act Statement is requested,
please contact the FNS Privacy Officer in the Information Management
Branch.
20. See OMB mem M-17-21 for more information. Answer yes if there is a
reduction in burden due to program changes.
21. Certification
Signature certifies that the collection of information encompassed by the
request complies with 5 CFR 1230.9. Provisions of this certification that
the agency cannot comply with or that do no apply should be identified in
the Supporting Statement Part A.

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