Information Collection

Supplemental Nutrition Assistance Program: Demonstration Projects

IC 272138 under ICR 202410-0584-007 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appendix C Simplified CAP Demo Request Template.docx	Instruction
Appendix D ESAP Demo Request Template.docx	Instruction
Appendix G ESAP Reporting Template (Change Reporting).xlsx	Instruction
Appendix H ESAP Reporting Template (Elderly Only - Waive Periodic Report).xlsx	Instruction
Appendix I ESAP Reporting Template (Waive Periodic Report) 1.xlsx	Instruction
Appendix J SMD Reporting Template.xlsx	Instruction
Appendix K Summary of SNAP State Options Report Option Profiles and Example Questions.docx SNAP State Options Report	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction	Appendix C Simplified CAP Demo Request Template.docx	Yes	Yes	Fillable Printable
Instruction	Appendix D ESAP Demo Request Template.docx	Yes	Yes	Fillable Printable
Instruction	Appendix G ESAP Reporting Template (Change Reporting).xlsx	Yes	Yes	Fillable Printable
Instruction	Appendix H ESAP Reporting Template (Elderly Only - Waive Periodic Report).xlsx	Yes	Yes	Fillable Printable
Instruction	Appendix I ESAP Reporting Template (Waive Periodic Report) 1.xlsx	Yes	Yes	Fillable Printable
Instruction	Appendix J SMD Reporting Template.xlsx	Yes	Yes	Fillable Printable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 53

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	145	145
Annual IC Time Burden (Hours)	16,658	16,658
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SNAP State Options Report	Appendix K Summary of SNAP State Options Report Option Profiles and Example Questions.docx	11/05/2024

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