Information Collection

Waiver Under Section 6(o) of the Food Stamp Act (State Agencies)

IC 3082 under ICR 202211-0584-004 · OMB 0584-0479.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0479 can be found here:

Documents and Forms

Document Name Document Type
Appendix F_ABAWD Request Template_0584-0479_Updated.docx wims.fns.usda.gov Other-Appendix F_ABAWD Request Templ
Appendix F_ABAWD Request Template_0584-0479_Updated.docx wims.fns.usda.gov Other-Appendix F_ABAWD Request Templ
Appendix G.1_WIMS Public Burden Statement_0584-0479.jpg wims.fns.usda.gov Other-Appendix G.1_WIMS Public Burde
Appendix G.1_WIMS Public Burden Statement_0584-0479.jpg wims.fns.usda.gov Other-Appendix G.1_WIMS Public Burde
Appendix G_WIMS Request Screenshot_0584-0479.jpg wims.fns.usda.gov Other-Appendix G_WIMS Request Screen
Appendix G_WIMS Request Screenshot_0584-0479.jpg wims.fns.usda.gov Other-Appendix G_WIMS Request Screen
Appendix C_FNS-366A Screenshot_0584-0479.jpg Appendix C_FNS-366A Screenshot_0584-0479 IC Document
Appendix C_FNS-366A Screenshot_0584-0479.jpg Appendix C_FNS-366A Screenshot_0584-0479 IC Document
Appendix D_FNS-366B Screenshot_0584-0479.jpg Appendix D_FNS-366B Screenshot_0584-0479 IC Document
Appendix D_FNS-366B Screenshot_0584-0479.jpg Appendix D_FNS-366B Screenshot_0584-0479 IC Document
Appendix E_FPRS Public Burden Statement_0584-0479.pdf Appendix E_FPRS Public Burden Statement_0584-0479 IC Document
Appendix E_FPRS Public Burden Statement_0584-0479.pdf Appendix E_FPRS Public Burden Statement_0584-0479 IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Waiver Under Section 6(o) of the Food Stamp Act (State Agencies)	Agency IC Tracking Number:	VACATE ABAWD 0584-AE57

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 7 CFR 273.24

Information Collection Instruments:

Document Type	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Appendix F_ABAWD Request Template_0584-0479_Updated	Appendix F_ABAWD Request Template_0584-0479_Updated.docx	https://wims.fns.usda.gov	Yes	Yes	Fillable Fileable Signable
Other-Appendix G.1_WIMS Public Burden Statement_0584-0479	Appendix G.1_WIMS Public Burden Statement_0584-0479.jpg	https://wims.fns.usda.gov	Yes	Yes	Fillable Fileable Signable
Other-Appendix G_WIMS Request Screenshot_0584-0479	Appendix G_WIMS Request Screenshot_0584-0479.jpg	https://wims.fns.usda.gov	Yes	Yes	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records
Title: USDA/FNS-10 Entitled Persons Doing Business with the Food and Nutrition Service	FR Citation: 65 FR 17251

Number of Respondents: 35	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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	35	-1,087,034	-3	1,087,072
Annual IC Time Burden (Hours)	1,163	-84,221	-105	85,489
Annual IC Cost Burden (Dollars)	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Appendix C_FNS-366A Screenshot_0584-0479	Appendix C_FNS-366A Screenshot_0584-0479.jpg	12/20/2022
Appendix D_FNS-366B Screenshot_0584-0479	Appendix D_FNS-366B Screenshot_0584-0479.jpg	12/20/2022
Appendix E_FPRS Public Burden Statement_0584-0479	Appendix E_FPRS Public Burden Statement_0584-0479.pdf	12/20/2022

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