Fns-843, Fns 844

CACFP National Disqualified List - Forms FNS-843, FNS-844

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Form FNS-843 FNS-843, FNS 844 Form and Instruction
FNS-843 Report of Disqualification from Participation-Institutio FNS-843.pdf Form and Instruction
FNS-843 (online) NDL Add DQ Institution Screen - FNS-843 NDL Add DQ Institution Screen - FNS-843.png www.fns.usda.gov Form and Instruction
FNS-844 Report of Disqualification from Participation-Individual FNS-844.pdf Form and Instruction
FNS-844 (online) NDL Add DQ Individual Screen - FNS-844 NDL Add DQ Individual Screen - FNS-844.png www.fns.usda.gov Form and Instruction

Information Collection (IC) Details

IC Title:	FNS-843, FNS 844	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 7 CFR 226.6(c)(8)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	FNS-843	Report of Disqualification from Participation-Institutions and Responsible Principals/Individuals	FNS-843.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	FNS-843 (online)	NDL Add DQ Institution Screen - FNS-843	NDL Add DQ Institution Screen - FNS-843.png	www.fns.usda.gov	Yes	Yes	Fillable Fileable
Form and Instruction	FNS-844	Report of Disqualification from Participation-Individually Disqualified Responsible Principal/Individual or Day Care Home Provider	FNS-844.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	FNS-844 (online)	NDL Add DQ Individual Screen - FNS-844	NDL Add DQ Individual Screen - FNS-844.png	www.fns.usda.gov	Yes	Yes	Fillable Fileable

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records
Title: USDA/FNS-11 Information on Persons Identified as Responsible for Serious Deficiencies, Proposed for Disqualification, or Disqualified to Participate as Principals or Family Day Care Home Operators in	FR Citation: 69 FR 6933

Number of Respondents: 56	Number of Respondents for Small Entity: 5

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,568	1,568
Annual IC Time Burden (Hours)	784	784
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.