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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Healthy School Environment
Agency IC Tracking Number:
IC Status:
Unchanged
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Other-Screening Questionnaire
A_FNS screener_students_Revised nov30.docx
No
Paper Only
Other-Parent - Screening Questionnaire
B_FNS screener_parents_Revised nov30.docx
No
Paper Only
Other-Teacher - Screening Questionnaire
C_Screener_Teachers_Revised nov30.docx
No
Paper Only
Other-Principal - Screening Questionnaire
D_FNS screener_principals_Revised nov30.docx
No
Paper Only
Other-FSM - Screening Questionnaire
E_Screener_Food Service Managers_Revised nov30.docx
No
Paper Only
Other-Student - Focus Group Moderator Guide
F_Formative Guide_Students.docx
No
Paper Only
Other-Parent - Focus Group Moderator Guide
G_Formative Guide_Parents_Revised.docx
No
Paper Only
Other-Teacher - Focus Group Moderator Guide
H_Formative Guide_Teachers_Revised.docx
No
Paper Only
Other-Principal - Focus Group Moderator Guide
I_Formative Guide_Principals_Revised.docx
No
Paper Only
Other-FSM - Focus Group Moderator Guide
J_Formative Guide_Food Service Managers_Revised.docx
No
Paper Only
Other-Security Agreement - Adults
P - Agreement on Security of Comments_Adults_Revised.docx
No
Paper Only
Other-Security Agreement - Parent of Children in Focus Group
Q - Agreement on Security of Comments_parents_Revised.docx
No
Paper Only
Other-Consent Form
R - Parental consent form.docx
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:
4,308
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Requested
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
4,308
0
0
0
0
4,308
Annual IC Time Burden (Hours)
764
0
0
0
0
764
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Justification Memo
OMB Justification Request FINAL_Revised dec20_formative only.docx
12/20/2010
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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