Information Collection

Individuals

IC 268907 under ICR 202406-0584-003 · OMB 0584-0699.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0699 can be found here:

Documents and Forms

Document Name Document Type
Attachment C. Survey Instrument 08072024.docx Other-Attachment C. Survey Instrumen
Attachment C. Survey Instrument 08072024.docx Other-Attachment C. Survey Instrumen

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Individuals	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-Attachment C. Survey Instrument 08072024			Attachment C. Survey Instrument 08072024.docx		Yes	Yes	Fillable Fileable

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 6	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	6	6
Annual IC Time Burden (Hours)	9	9
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.