Information Collection

Monthly Claim For Reimbursement

IC 103243 under ICR 199305-0584-001 · OMB 0584-0284.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0284 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	MONTHLY CLAIM FOR REIMBURSEMENT	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	FNS-806				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 584	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	5,256	36	5,220
Annual IC Time Burden (Hours)	8,111	55	8,056
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded

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