State Agencies - CACFP and SFSP

Child and Adult Care Food Program (CACFP) and Summer Food Service Program (SFSP) National Disqualified List

Documents and Forms

Document Name Document Type
Form FNS-843 State Agencies - CACFP and SFSP Form
FNS-843 Report of Disqualification from Participation: Instituti Attachment_C_FNS_843.docx Form
FNS-844 Report of Disqualification from Participation: Individua Attachment_D_FNS_844.pdf Form

Information Collection (IC) Details

IC Title:	State Agencies - CACFP and SFSP	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 7 CFR 226.6(c)(8) 7 CFR 225.18(e)(2)(i)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	FNS-843	Report of Disqualification from Participation: Institution and Responsible Principals/Individuals	Attachment_C_FNS_843.docx		Yes	Yes	Fillable Fileable
Form	FNS-844	Report of Disqualification from Participation: Individually Disqualified Responsible Principal/Individual or Day Care Home Provider	Attachment_D_FNS_844.pdf		Yes	Yes	Fillable Fileable

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: 109	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	2,045	477	1,568
Annual IC Time Burden (Hours)	1,023	239	784
Annual IC Cost Burden (Dollars)	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.