(State Agencies) - ABAWD Startup

Supplemental Nutrition Assistance Program: Work Requirements and Screening

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 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 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 E_FPRS Public Burden Statement_0584-0479.pdf Appendix E_FPRS Public Burden Statement_0584-0479 IC Document

Information Collection (IC) Details

IC Title:	(State Agencies) - ABAWD Startup	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(k), 7 CFR 273.24(l) 7 CFR 7 CFR 273.24(c)(7), (8), (9), 7 CFR 273.7(b) 7 CFR 7 CFR 273.24(c) (10),

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: 105,189	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	105,189	105,154	35
Annual IC Time Burden (Hours)	469,177	468,014	1,163
Annual IC Cost Burden (Dollars)	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.