Information Collection

WIC Federal and State Agreement

IC 43553 under ICR 201701-0584-001 · OMB 0584-0332.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0332 can be found here:

Documents and Forms

Document Name Document Type
Form FNS 339 WIC Federal and State Agreement Form and Instruction
FNS 339 Federal State Supplemental Nutrition Programs Agreement FNS-339 exp. 2-28-19 revision request Jan 2017.pdf www.fns.usda.gov/fns/forms.htm Form and Instruction
Justification for Change Memo FNS-339.pdf Change Justification Memo for FNS 339 IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	WIC Federal and State Agreement	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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 and Instruction	FNS 339	Federal State Supplemental Nutrition Programs Agreement	FNS-339 exp. 2-28-19 revision request Jan 2017.pdf	http://www.fns.usda.gov/fns/forms.htm	Yes	No	Fillable Printable

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 188	Number of Respondents for Small Entity: 56

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	124	124
Annual IC Time Burden (Hours)	31	31
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Change Justification Memo for FNS 339	Justification for Change Memo FNS-339.pdf	01/03/2017

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