Information Collection

State Agency Requirement - Reporting

IC 3061 under ICR 201511-0584-003 · OMB 0584-0446.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0446 can be found here:

Documents and Forms

Document Name Document Type
209 Screenshots.docx FNS Worksheet 209 Approved under FPRS 0594 IC Document
0584-0594 FPRS PBStatement _ExpDatDisplayed 7-16-14.pdf FPRS Burden Statement for all FNS Worksheet IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	State Agency Requirement - Reporting	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 7 CFR 278.18

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: Claims Against Food Stamp Recipients	FR Citation: 69 FR 16513

Number of Respondents: 53	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 99 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	264,326	-4,183	268,509
Annual IC Time Burden (Hours)	21,917	-145	22,062
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
FNS Worksheet 209 Approved under FPRS 0594	209 Screenshots.docx	02/29/2016
FPRS Burden Statement for all FNS Worksheet	0584-0594 FPRS PBStatement _ExpDatDisplayed 7-16-14.pdf	02/29/2016

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