Information Collection

State Agency (49); Local Agency (696)

IC 184656 under ICR 202105-0584-005 · OMB 0584-0447.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0447 can be found here:

2024-07-08 - Revision of a currently approved collection

Documents and Forms

Document Name Document Type
Appendix F- FY21 Consolidated State Plan Guidance Complete .pdf Other-Appendix F Consolidated State
Appendix F- FY21 Consolidated State Plan Guidance Complete .pdf Other-Appendix F Consolidated State
Appendix G- FY21 FMNP State Plan Guidance Complete.pdf Other-Appendix G WIC FMNP State Plan
Appendix G- FY21 FMNP State Plan Guidance Complete.pdf Other-Appendix G WIC FMNP State Plan
Appendix H- Upload Procedures for SFPD State Plans.docx Other-Appendix H Upload Procedures f
Appendix H- Upload Procedures for SFPD State Plans.docx Other-Appendix H Upload Procedures f
Appendix I Annual Financial and Program Data Report FNS-683B (1).jpg Appendix I Annual Financial and Program Data Report IC Document
Appendix I Annual Financial and Program Data Report FNS-683B (1).jpg Appendix I Annual Financial and Program Data Report IC Document
Appendix Ia Annual Financial and Program Data Report FNS-683B (1) Remarks section.pdf Appendix Ia Annual Financial and Program Data Report and Remarks IC Document
Appendix Ia Annual Financial and Program Data Report FNS-683B (1) Remarks section.pdf Appendix Ia Annual Financial and Program Data Report and Remarks IC Document
Appendix J- WIC Federal and State Agreements.pdf Appendix J WIC Federal and State Agreements IC Document
Appendix J- WIC Federal and State Agreements.pdf Appendix J WIC Federal and State Agreements IC Document
Appendix L FPRS Home Page with OMB Information.pdf Appendix L FPRS Home Page with OMB Disclosure Statement IC Document
Appendix L FPRS Home Page with OMB Information.pdf Appendix L FPRS Home Page with OMB Disclosure Statement IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	State Agency (49); Local Agency (696)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 7 CFR 248.10(b)(5) 7 CFR 246.5 7 CFR 248.10(a)(4)(d) 7 CFR 248.10(b)(c) 7 CFR 248.4 7 CFR 248.6 7 CFR 248.10(i) 7 CFR 248.10(a)(4)(d) 7 CFR 248.10(b)(5) 7 CFR 248.10(d) 7 CFR 248.3(e) 7 CFR 248.10(e)(2), (3) 7 CFR 248.17(c)(1)(i) 7 CFR 248.10(e)(4) 7 CFR 248.10(f) 7 CFR 248.10(h) 7 CFR 248.10(j) 7 CFR 248.10(k) 7 CFR 248.11(a) 7 CFR 248.17(a) 7 CFR 248.17(b)(2)(ii) 7 CFR 248.17(c)(2) 7 CFR 248.18(b) 7 CFR 248.4(c) 7 CFR 248.9 7 CFR 248.16(a) 7 CFR 248.23(a) 7 CFR 248.11(c)

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Appendix F Consolidated State Plan Guidance	Appendix F- FY21 Consolidated State Plan Guidance Complete .pdf	Yes	No	Fillable Printable
Other-Appendix G WIC FMNP State Plan Guidance	Appendix G- FY21 FMNP State Plan Guidance Complete.pdf	Yes	No	Fillable Printable
Other-Appendix H Upload Procedures for SFPD State Plans	Appendix H- Upload Procedures for SFPD State Plans.docx	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 744	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 48 %

	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	3,139,280	6,905	-176,815	3,309,190
Annual IC Time Burden (Hours)	805,741	5,756	-45,848	845,833
Annual IC Cost Burden (Dollars)	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Appendix I Annual Financial and Program Data Report	Appendix I Annual Financial and Program Data Report FNS-683B (1).jpg	05/27/2021
Appendix Ia Annual Financial and Program Data Report and Remarks	Appendix Ia Annual Financial and Program Data Report FNS-683B (1) Remarks section.pdf	05/27/2021
Appendix J WIC Federal and State Agreements	Appendix J- WIC Federal and State Agreements.pdf	05/27/2021
Appendix L FPRS Home Page with OMB Disclosure Statement	Appendix L FPRS Home Page with OMB Information.pdf	05/27/2021

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