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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
SNAP Teen Nutrition Pilot Test (State Agencies - Teachers)
Agency IC Tracking Number:
IC Status:
New
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-Attachment A - Quantitative Evaluation Survey for High School Students 0...-1
Attachment A - Quantitative Evaluation Survey for High School Students 0...-1.docx
https://krcresearch.az1.qualtrics.com/SE/?SID=SV_czIsBramP7KBuPb
Yes
Yes
Fillable Fileable Signable
Other-Attachment B - Moderator PRE - Discussion Guide for Focus Groups with Hi...
Attachment B - Moderator PRE - Discussion Guide for Focus Groups with Hi....docx
No
Paper Only
Other-Attachment C - Moderator POST - Discussion Guide for Focus Groups with High School Students 060116
Attachment C - Moderator POST - Discussion Guide for Focus Groups with High School Students060116.docx
No
Paper Only
Other-Attachment D - Moderator PRE - Discussion Guide for Focus Groups with High School Teachers 052516
Attachment D - Moderator PRE - Discussion Guide for Focus Groups with High School Teachers 060116.docx
No
Paper Only
Other-Attachment E- Moderator POST - Discussion Guide for Focus Groups with High School Teachers 060116
Attachment E- Moderator POST - Discussion Guide for Focus Groups with High School Teachers 060116.docx
No
Paper Only
Other-Attachment F - Parent Guardian Focus Group Consent Form for Student Participation 060116
Attachment F - Parent Guardian Focus Group Consent Form for Student Participation 060116.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:
11
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
0 %
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
33
0
33
0
0
0
Annual IC Time Burden (Hours)
55
0
55
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
0584-0606 FNS SNAP Teen Nutrition Pilot Test OMB Package Memo 6-2-16 clean version
0584-0606 FNS SNAP Teen Nutrition Pilot Test OMB Package Memo 6-2-16 clean version-1.docx
06/02/2016
Attachment G - Teen Nutrition and Physical Activity Program 060216
Attachment G - Teen Nutrition and Physical Activity Program 060216.pdf
06/02/2016
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.