Information Collection

State Agencies

IC 227921 under ICR 201702-0584-002 · OMB 0584-0631.

Documents and Forms

Document Name Document Type
APPENDIX V- STATE AGENCY ADMINISTRATIVE CASE RECORD DATA.docx Other-Appendix V State Agency Admins

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	State Agencies	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-Appendix V State Agency Adminstrative Case Record Data			APPENDIX V- STATE AGENCY ADMINISTRATIVE CASE RECORD DATA.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: 26	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	26	26
Annual IC Time Burden (Hours)	26	26
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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