Information Collection

SNAP, WIC, FMNP, and CN COVID-19 Waivers, Evaluation, and Reporting Data - State Agencies and WIC Local Government (SLT)

IC 241637 under ICR 202004-0584-004 · OMB 0584-0654.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0654 can be found here:

Documents and Forms

Document Name Document Type
Attachment C Example FFCRA SNAP Waiver Request Template.docx Other-Attachment C Example FFCRA SNA
Attachment D Example WIC Waiver Request Template.pdf Other-Attachment D Example WIC Waive
Attachment E Example FMNP Waiver Request Template.pdf Other-Attachment E Example FMNP Waiv
Attachment H FNS292A.pdf Attachment H FNS 292A IC Document
Attachment I FNS-418.pdf Attachment I FNS 418 IC Document
Attachment J FNS-10.pdf Attachment J FNS10 IC Document
Attachment K FNS-44.pdf Attachment K FNS 44 IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	SNAP, WIC, FMNP, and CN COVID-19 Waivers, Evaluation, and Reporting Data - State Agencies and WIC Local Government (SLT)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Attachment C Example FFCRA SNAP Waiver Request Template	Attachment C Example FFCRA SNAP Waiver Request Template.docx	No		Paper Only
Other-Attachment D Example WIC Waiver Request Template	Attachment D Example WIC Waiver Request Template.pdf	Yes	Yes	Fillable Fileable
Other-Attachment E Example FMNP Waiver Request Template	Attachment E Example FMNP Waiver Request Template.pdf	No		Fillable Printable

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,068	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 62 %

	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	5,994	5,994
Annual IC Time Burden (Hours)	6,996	6,996
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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