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 | APPENDIX F- OMB 0584-0299 | 
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		| Reporting Burden | 
	
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		| Reporting Burden for Individuals/Households FNS 380-1, OMB 0584-0299 | 
	
		| Form Number | Reg. Section | Description of Activity | No. of Respondents | Est. No. of Responses per Respondent | Est. Total Annual Responses | No. Hours per Response | Est. Total Burden Hours | 
	
		| FNS-380-1 | 275.12(f) | Reporting of Review Findings | 53 | 858.4340 | 45,497.0000 | 1.056 | 48,044.8320 | 
	
		
	
		
	
		
	
		
	
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		| Record Keeping Burden | 
	
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		| Recordkeeping Burden for Individuals/Households FNS 380-1, OMB 0584-0299 | 
	
		| Form Number | Reg. Section | Description of Activity | No. of Record keepers | Est. No. of Records per Record keeper | Est. Total Annual Responses | No. Hours per Record to be Maintained | Est. Total Burden Hours | 
	
		| FNS-380-1 | 275.4 | Record Retention | 53 | 858.4340 | 45,497.0000 | 0.0236 | 1073.7292 | 
	
		
	
		
	
		| Grand Total Reporting and Recordkeeping Burden | 
 | 53 | 1716.87 | 90994 | 1.0796 | 49118.56 | 
	
	
	
	
	
	
	
		| Estimates of Annualized Cost to Federal Government | 
	
		| Reporting and Recordkeeping Cost for FNS 380, OMB 0584-0074 | 
	
		| Activities | Hours Spent on Collection | Costs or Hourly Wage Rage | Total Cost | Fringe Benefits Cost for Staff (0.33) | Overall Base Cost w/ Fringe Benefits for Staff | 
	
		| 1.  Printing Cost | N/A | $2,000.00 | $2,000.00 | N/A | $2,000.00 | 
	
		| 2.  50% Reimbursement Cost to States for reporting & recordkeeping administrative cost | N/A | $584,265.29 | $584,265.29 | $192,807.55 | $777,072.84 | 
	
		| 3.  2 Regional Federal Staff (GS 12 Step 6) | N/A | $194,600.00 | $194,600.00 | $64,218.00 | $258,818.00 | 
	
		| 4a .Program Analyst GS 12 Step 6 Estimates of Annualized Cost to Federal Government for drafting, reviewing & approving ICR | 80 | $46.62 | $3,729.60 | $1,230.77 | $4,960.37 | 
	
		| 4b. Program Branch Chief Estimates of Annualized Cost to Federal Government for drafting, reviewing & approving ICR | 10 | $56.15 | $561.50 | $185.30 | $746.80 | 
	
		| 4c. Program Division Director Estimates of Annualized Cost to Federal Government for drafting, reviewing & approving ICR | 5 | $66.05 | $330.25 | $108.98 | $439.23 | 
	
		| 5. Automated System Cost (includes fringe benefits in fixed rate Contractor Monitoring) | N/A | $180,000.00 | $180,000.00 | N/A | $180,000.00 | 
	
		| Grand Total Cost to Government | 
 | $961,034.11 | $965,486.64 | $258,550.59 | $1,224,037.23 |