Information Collection

State, Local and Tribal Agencies (Non-Respondents)

IC 228064 under ICR 201708-0584-002 · OMB 0584-0633.

Documents and Forms

Document Name Document Type
Non-Respondent Placeholder.docx www.qualtrics.com Other-NON RESPONDENT INSTRUMENT

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	State, Local and Tribal 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-NON RESPONDENT INSTRUMENT			Non-Respondent Placeholder.docx	www.qualtrics.com	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: 151	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	151	151
Annual IC Time Burden (Hours)	15	15
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.