View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	State and Local Government	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-04_D. Electronic Letter to States with Data Request			04_D. Electronic Letter to States with Data Request.docx		Yes	Yes	Printable Only
Other-05_E. Reminder Electronic Letter to States with Data Request			05_E. Reminder Electronic Letter to States with Data Request.docx		Yes	Yes	Printable Only
Other-06_F. State Administrative Cost Template			06_F. State Administrative Cost Template.xlsx		Yes	Yes	Fillable Fileable
Other-07_G. Incentive Report Template			07_G. Incentive Report Template.xlsx		Yes	Yes	Fillable Fileable
Other-08_H. Retailer list			08_H. Retailer list.xlsx		Yes	Yes	Fillable Fileable
Other-09_I.Electronic Letter with Request to Schedule Interview - fns			09_I.Electronic Letter with Request to Schedule Interview - fns.docx		Yes	Yes	Printable Only
Other-10_J.Electronic Letter with Reminder to Schedule Interview			10_J.Electronic Letter with Reminder to Schedule Interview.docx		Yes	Yes	Printable Only
Other-11_K.Electronic Letter with Reminder about Interview			11_K.Electronic Letter with Reminder about Interview.docx		Yes	Yes	Printable Only
Other-12_L. In-Depth Interview Protocol			12_L. In-Depth Interview Protocol.docx		No		Paper Only
Other-14_N. Interview Consent Form			14_N. Interview Consent Form.docx		Yes	Yes	Printable Only
Other-15_O. Interview Follow Up and Thank You Note			15_O. Interview Follow Up and Thank You Note.docx		Yes	Yes	Printable Only
Other-23_V. Pretest Protocol			23_V. Pretest Protocol.docx		Yes	Yes	Fillable Fileable
Other-13_M. Interview Worksheets			13_M. Interview Worksheets.xlsx		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: 12	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 New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	90	0	90	0	0	0
Annual IC Time Burden (Hours)	93	0	93	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	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.