Information Collection

Worksheet FNS 209 OMB# 0069

IC 204659 under ICR 201504-0584-002 · OMB 0584-0594.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0594 can be found here:

Documents and Forms

Document Name Document Type
Form FNS 209 Screenshot Worksheet FNS 209 OMB# 0069 Form and Instruction
FNS 209 April 2014.pdf fprs.fns.usda.gov Instruction
FNS 209 Screenshot Status of Claims Against Households FNS-209 Screenshots V2.pdf https:/fprs.fns.usda.gov Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Worksheet FNS 209 OMB# 0069	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Mandatory

CFR Citation: 7 CFR 273.18

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	FNS 209 Screenshot	Status of Claims Against Households	FNS-209 Screenshots V2.pdf	https:/fprs.fns.usda.gov	Yes	Yes	Fillable Fileable Signable
Instruction			FNS 209 April 2014.pdf	https://fprs.fns.usda.gov	Yes	Yes	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

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 %

	Approved	Previously Approved
Annual Number of Responses for this IC	212	212
Annual IC Time Burden (Hours)	636	636
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.