Information Collection

Fns-874

IC 219419 under ICR 202303-0584-001 · OMB 0584-0594.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0594 can be found here:

Documents and Forms

Document Name Document Type
FNS-874.pdf fprs.fns.usda.gov Instruction
FNS-874.pdf fprs.fns.usda.gov Instruction
FNS-874.docx fprs.usda.fns.gov Other-FNS 874 worksheet
FNS-874.docx fprs.usda.fns.gov Other-FNS 874 worksheet

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	FNS-874	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			FNS-874.pdf	https://fprs.fns.usda.gov	Yes	Yes	Fillable Fileable Signable
Other-FNS 874 worksheet			FNS-874.docx	https://fprs.usda.fns.gov	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: 56	Number of Respondents for Small Entity: 44

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	56	-1,400	1,456
Annual IC Time Burden (Hours)	280	-98	378
Annual IC Cost Burden (Dollars)	0	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.