Information Collection

State Agencies (non-respondents)

IC 214690 under ICR 201411-0584-004 · OMB 0584-0602.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0602 can be found here:

Documents and Forms

Document Name Document Type
NON-RESPONDENT PLACE HOLDER.docx Other-STATE AGENCY NON RESPONDENT PL

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	STATE AGENCIES (NON-RESPONDENTS)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-STATE AGENCY NON RESPONDENT PLACE HOLDER			NON-RESPONDENT PLACE HOLDER.docx		No		Paper Only

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	4	4
Annual IC Time Burden (Hours)	0	0
Annual IC Cost Burden (Dollars)	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.