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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
State and Local Burden - SA, SFA/LEA/Schools
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
7 CFR 210.18(i)(3)
7 CFR 210.20(b)(7)
7 CFR 210.19(c)
7 CFR 210.18(o)
7 CFR 210.20(b)(10)
7 CFR 210.19(b)
7 CFR 210.20(b)(12)
7 CFR 210.14(e)(7)
7 CFR 210.15(b)(1)
7 CFR 210.15(b)(2)(3)
7 CFR 210.13(b & c)
7 CFR 210.20(b)(14)
7 CFR 210.8(a)(5)
7 CFR 210.15(b)(2)
7 CFR 210.7(d)(2)
7 CFR 210.18(c-h)
7 CFR 210.13(b)
7 CFR 210.18(h)(2)(iv)
7 CFR 210.31e(2),e(3)
7 CFR 210
7 CFR 210.11(b)(2)
7 CFR 210.15(a)(7)/
7 CFR 210.8(a)(5)/
7 CFR 210.5(d)(2)(ii)
7 CFR 210.5
7 CFR 210.20(b)(3)
7 CFR 210.17 (g) & (h)
7 CFR 210.20(b)(6)
7 CFR 210.5(d)(2)(ii)
7 CFR 210.9(b)(21),(c)(7)
7 CFR 210.15(a)(3)
7 CFR 210.20(a)(7)
7 CFR 210.15(a)(1) &210.8(b)&(c)
7 CFR 210.15(b)(1)
7 CFR 210.18(j)(2)
7 CFR 210.15(a)(8)
7 CFR 210.14(e)
7 CFR 210.20(b)(1 & 2)
7 CFR 210.23(c)
7 CFR 210.18(f)(k,l,m,o)
7 CFR 210.15(b)(4)
7 CFR 210.9(b)(18 & 20)
7 CFR 210.9(a & b)
7 CFR 210.15(b)(6)
7 CFR 210.14(f)
7 CFR 210.15(b)(7) & (b)(8)
7 CFR 210.30(g)
7 CFR 210.15(b)(9)
7 CFR 210.31(f)
7 CFR 210.10(m)
7 CFR 210.11(b)(2)
7 CFR 210.9(b)(19)
7 CFR 210.31(d)(2),(3), e(2), e(3)
7 CFR 210.19(f)
7 CFR 210.15(a)(2) & (4)
7 CFR 210.18(m)(1)
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Other-Attachment N1 Off-site Assessment Tool
Attachment N1. Off-site Assessment Tool.pdf
No
Paper Only
Other-Attachment N2 On-site Assessment Tool
Attachment N2. On-site Assessment Tool.pdf
No
Paper Only
Other-Attachment N3 Site Selection Worksheet
Attachment N3. Site Selection Worksheet.pdf
No
Paper Only
Other-Attachment N4 Statistical Sample Generator
Attachment N4.Statistical Sample Generator.pdf
No
Paper Only
Other-Attachment N5 Meal Compliance Risk Assessment Tool
Attachment N5. Meal Compliance Risk Assessment Tool.pdf
No
Paper Only
Other-Attachment N6 Dietary Specifications Assessment Tool
Attachment N6. Dietary Specifications Assessment Tool.pdf
No
Paper Only
Other-Attachment N7 Nutrient Analysis and Validation Checklist
Attachment N7. Nutrient Analysis and Validation Checklist.pdf
No
Paper Only
Other-Attachment N8 Nutrient Analysis Protocols
Attachment N8. Nutrient Analysis Protocols.pdf
No
Paper Only
Other-Attachment N9 Resource Management Comprehensive Review Form
Attachment N9. Resource Management Comprehensive Review Form.pdf
No
Paper Only
Other-Attachment N10 Resource Management Risk Indicator Tool
Attachment N10. Resource Management Risk Indicator Tool.pdf
No
Paper Only
Other-Attachment N11 Fiscal Action Workbook
Attachment N11. Fiscal Action Workbook.xlsx
No
Paper Only
Other-Attachment N12 Non-reimbursable Meal Allocation Form
Attachment N12. Non-reimbursable Meal Allocation Form.pdf
No
Paper Only
Other-Attachment N13 School Data and Meal Pattern Error Form (S-1)
Attachment N13. School Data and Meal Pattern Error Form (S-1).pdf
No
Paper Only
Other-Attachment N14 Other Meal Claim Errors (S-2)
Attachment N14. Other Meal Claim Errors (S-2).pdf
No
Paper Only
Other-Attachment N15 Eligibility Certification and Benefit Issuance Error Worksheet (SFA-1)
Attachment N15. Eligibility and Certification and Benefit Issuance Error Worksheet.pdf
No
Paper Only
Other-Attachment N16 Other Eligibility Certification and Benefit Issuance Errors Worksheet (SFA-2)
Attachment N16. Other Eligibility Certification and Benefit Issuance Errors Worksheet (SFA-2).pdf
No
Paper Only
Other-Attachment N17 SFA Data Summary Form (SFA-3)
Attachment N17. SFA Data Summary Form (SFA-3).pdf
No
Paper Only
Other-Attachment N18 Special Provisions Non-Base Year and CEP Claiming Percentage/Funding Level Summary Form (SFA-1A)
Attachment N18. Special Provisions Non-Base Year and CEP Claiming Percentage Funding Level Summary Form SFA-1A.pdf
No
Paper Only
Other-Attachment N19 Community Eligibility Provision ISP and Claiming Percentage Validation Worksheet (SFA-2A)
Attachment N19. Community Eligibility Provision ISP and Claiming Percentage Validation Worksheet (SFA-2A).pdf
No
Paper Only
Other-Attachment N20 Seamless Summer Option School Data and Meal Pattern Error Form (SSO S-1)
Attachment N20. Seamless Summer Option School Data and Meal Pattern Error Form (SSO S-1).pdf
No
Paper Only
Other-Attachment N21 Seamless Summer Option Eligibility Certification Form (SSO S-2)
Attachment N21. Seamless Summer Option Eligibility Certification Form (SSO S-2).pdf
No
Paper Only
Other-Attachment N22 Supplemental Seamless Summer Option Administrative Review Form
Attachment N22. Supplemental Seamless Summer Option Administrative Review Form.pdf
No
Paper Only
Other-Attachment N23 Supplemental Afterschool Snacks Administrative Review Form
Attachment N23. Supplemental Afterschool Snacks Administrative Review Form.pdf
No
Paper Only
Other-Attachment N24 Supplemental Special Milk Program Administrative Review Form
Attachment N24. Supplemental Special Milk Program Administrative Review Form.pdf
No
Paper Only
Other-Attachment N25 Infant and Pre-K Meal Pattern On-Site Validation Checklist
Attachment N25. Infant and Pre-K Meal Pattern On-Site Validation Checklist.pdf
No
Paper Only
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:
115,935
Number of Respondents for Small Entity:
115,499
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
96 %
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
47,631,996
0
0
0
0
47,631,996
Annual IC Time Burden (Hours)
9,808,701
0
0
247
0
9,808,454
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Attachment C Form FNS-640 Administrative Review Data Report (OMB# 0584-0594)
Attachment C. Form FNS-640 Administrative Review Data Report.pdf
07/28/2023
Attachment D OMB# 0584-0594 Food Programs Reporting System (FPRS) Home Screen with OMB Information and Public Burden Statement
Attachment D. Food Programs Reporting System (FPRS) Home Screen with OMB Information and Public Burden Statement.pdf
07/28/2023
Attachment E Form FNS-10 Report of School Operations (OMB# 0584-0594)
Attachment E. FNS-10 Report of School Operations.pdf
07/28/2023
Attachment F Form FNS-13 Annual Report of State Revenue Matching (OMB# 0584-0594)
Attachment F. FNS-13 Annual Report of State Revenue Matching.pdf
07/28/2023
Attachment G Form FNS-828 School Food Authority Paid Lunch Price Report (OMB# 0584-0594)
Attachment G. FNS-828 School Food Authority Paid Lunch Price Report.pdf
07/28/2023
Attachment H Form FNS-777 Financial Status Report (OMB# 0584-0594)
Attachment H. FNS-777 Financial Status Report.pdf
07/28/2023
Attachment M Administrative Review Manual
Attachment M. Administrative Review Guidance Manual 2018_2019.pdf
07/28/2023
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.