Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Households: M - Household Survey Removed 0 0 0 Other-M.1-Household Survey
Other-M.2-Household_Survey_Spanish
Households: M - Household Survey (Non-Response) Removed 0 0 0 Other-Non-Respondent Placeholder
Individuals/Households - Households New 43614 8110 0 Other-Appendix D3. Household Survey Income Worksheet
Other-Appendix D4. Household Survey Income Worksheet - Spanish
Other-Appendix D5. Household Survey
Other-Appendix D6. Household Survey - Spanish
Other-Appendix D9. Household Survey Incentives Received Form
Other-Appendix D10. Household Survey Incentives Received Form - Spanish
Other-Appendix D13. Household Interview
Other-Appendix D14. Household Interview - Spanish
Other-Appendix D15. Household Interview Incentives Received Form
Other-Appendix D16. Household Interview Incentives Received Form - Spanish
Other-Appendix I1. Household Survey Consent Form
Other-Appendix I2. Household Survey Consent Form - Spanish
Other-Appendix T5. Household Survey Recruitment Contact Guide
Other-Appendix T6. Household Survey Recruitment Contact Guide - Spanish
Other-Appendix T7. Household Interview Recruitment Contact Guide
Other-Appendix T8. Household Interview Recruitment Contact Guide - Spanish
Individuals/Households - Households (Non-Respondents) New 4818 294 0 Other-Non Respondents Burden Instrument
Private Schools: C - SFA District Director Questionnaire Removed 0 0 0 Other-C - SFA District Director Questionnaire
Private Schools: D - SFA Reimbursement Claims Data Removed 0 0 0 Other-D.1-SFA Reimbursement Claim Verif - Month
Other-D.2-SFA Reimbursement Claim Verif Form-Week
Other-D.3-SFA Reimbursement Claim Verif Form-For All Schools
Private Schools: F - Certified and Denied Applicant Sampling Removed 0 0 0 Other-F.1-Student Sample Contact Info Form
Other-F.2-Newly Cert FRP
Private Schools: H - School Meal Count Verification Form Removed 0 0 0 Other-H.1-School Meal Count Form-Day
Other-H.2-School Meal Count Form-Week
Other-H.3-School Meal Count Verification Form-Target Month
Other-H.4-Supplemental Reporting Form (for Sampled School)
Private Schools: J - Changes in Student Certification and Enrollment Form Removed 0 0 0 Other-J - Changes in Student Certification and Enrollment Form - For All Schools
Private Schools: K -Participation Data Protocol Removed 0 0 0 Other-K - Participation Data Protocol- For All Schools
Private Schools: Telephone Interview for Survey Data Clarification Removed 0 0 0 Other-Unwritten Information Collection Instrument Placeholder
State, Local, and Tribal Government - State Child Nutrition Agency, SFA, and Schools New 10084 4521 0 Other-Appendix B1. SFA Request for E-Records (Non-CEP Schools for Household Sampling)
Other-Appendix B2. SFA Reminder for E-Records (Non-CEP Schools for Household Sampling)
Other-Appendix B3. SFA Request for E-Records (CEP Schools for ISP Data Abstraction)
Other-Appendix B4. SFA Reminder for E-Records (CEP Schools for ISP Data Abstraction)
Other-Appendix B5. SFA Pre-Visit Interview
Other-Appendix B7. Application Data Abstraction Form
Other-Appendix B8. Round 2 & 3 Application Data Abstraction Scheduling Email
Other-Appendix B9. SFA Reimbursement Claim Verification Form - Sampled Schools
Other-Appendix B10. SFA Reimbursement Consolidation and Claim Verification Form - All Schools
Other-Appendix B11. SFA Director Survey (web based)
Other-Appendix B12. SFA Director Interview (by phone)
Other-Appendix B13. SFA Meal Participation Data Request
Other-Appendix B14. State Meal Claim Data Request
Other-Appendix C1. School Pre-Visit Interview
Other-Appendix C3. Meal Transaction Observation Form
Other-Appendix C5. Cafeteria Manager Interview
Other-Appendix C6. School Meal Count Verification Form
Other-Appendix O2. Template E-Letter from FNS Regional Liaison to State Child Nutrition Director
Other-Appendix O3. State Follow Up Contact Guide
Other-Appendix O4. SFA Study Notification and School Data Verification E-Letter
Other-Appendix O5. SFA Follow Up Contact Guide (Study Notification and School Data Verification)
Other-Appendix O8. SFA School Sample Notification E-Letter
State, Local, and Tribal Government - State Child Nutrition Agency, SFA, and Schools (Non-respondents) New 500 117 0 Other-Non Respondents Burden Instrument
State/Local: C - SFA District Director Questionnaire Removed 0 0 0 Other-Attachment C - SFA District Director Questionnaire
State/Local: C - SFA District Director Questionnaire (Non-Response) Removed 0 0 0 Other-NON-RESPONDENT PLACE HOLDER
State/Local: D - SFA Reimbursement Claims Data Removed 0 0 0 Other-Attachment D.1-SFA Reimbursement Claim Verif - Month
Other-Attachment D.2-SFA Reimbursement Claim Verif - Week
Other-Attachment D.3 - Optional SFA Reimbursement Claim Verif Form-For All Schools
State/Local: F - Certified and Denied Applicant Sampling Removed 0 0 0 Other-F.1-Student Sample Contact Info Form
Other-F.2-Newly Cert FRP
State/Local: G - CEO Student Sampling Removed 0 0 0 Other-G - CEO Student Sampling File Documentation Form
State/Local: H - School Meal Count Verification Form Removed 0 0 0 Other-H.1-School Meal Count Form-Day
Other-H.2-School Meal Count Form-Week
Other-H.3-School Meal Count Verification Form-Target Month
Other-H.4-Supplemental Reporting Form (for Sampled School)
State/Local: J - Changes in Student Certification and Enrollment Form Removed 0 0 0 Other-J - Changes in Student Certification and Enrollment Form - For All Schools
State/Local: K - Participation Data Removed 0 0 0 Other-K - Participation Data Protocol- For All Schools
State/Local: O - Program Data Removed 0 0 0 Other-O.3-Administrative Data Items Being Rqst from State Agencies
State/Local: Telephone Interview for Survey Data Clarification Removed 0 0 0 Other-Unwritten Information Collection Instrument Placeholder
Total burden requested under this ICR: 59016 13042 0  
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