Information Collection

State & Local Agency's Requirements

IC 45202 under ICR 200609-0584-004 · OMB 0584-0541.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0541 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	State & Local Agency's Requirements	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 7 CFR 249.4 7 CFR 249.10 (b), (e), (f), and (h) 7 CFR 249.11 7 CFR 249.12 7 CFR 249.3(e) 7 CFR 249.17(b)(2) 7 CFR 249.18(b) 7 CFR 249.23(a) & (b) 7 CFR 249.16(a)

Information Collection Instruments:

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

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 517	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 16 %

	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	801,039	801,039
Annual IC Time Burden (Hours)	409,313	409,313
Annual IC Cost Burden (Dollars)	0	0

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