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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
State, Local, and Tribal Government - State Child Nutrition Agency, SFA, and Schools
Agency IC Tracking Number:
Is this a Common Form?
No
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-Appendix B1. SFA Request for E-Records (Non-CEP Schools for Household Sampling)
B01 SFA Request for E-Records (Non-CEP schools for Household Sampling).docx
Yes
Yes
Fillable Fileable
Other-Appendix B2. SFA Reminder for E-Records (Non-CEP Schools for Household Sampling)
B02 SFA Reminder for E-Records (Non-CEP Schools for Household Sampling).docx
Yes
Yes
Fillable Fileable
Other-Appendix B3. SFA Request for E-Records (CEP Schools for ISP Data Abstraction)
B03 SFA Request for E-Records (CEP Schools for ISP Data Abstraction).docx
Yes
Yes
Fillable Fileable
Other-Appendix B4. SFA Reminder for E-Records (CEP Schools for ISP Data Abstraction)
B04 SFA Reminder for E-Records (CEP Schools for ISP Data Abstraction).docx
Yes
Yes
Fillable Fileable
Other-Appendix B5. SFA Pre-Visit Interview
B05 SFA Pre-Visit Interview.docx
Yes
Yes
Paper Only
Other-Appendix B7. Application Data Abstraction Form
B07 Application Data Abstraction Form.docx
Yes
Yes
Fillable Fileable
Other-Appendix B8. Round 2 & 3 Application Data Abstraction Scheduling Email
B08 Round 2 & 3 Application Data Abstraction Scheduling Email.docx
Yes
Yes
Fillable Fileable
Other-Appendix B9. SFA Reimbursement Claim Verification Form - Sampled Schools
B09 SFA Reimbursement Claim Verification Form - Sampled Schools.docx
Yes
Yes
Fillable Fileable
Other-Appendix B10. SFA Reimbursement Consolidation and Claim Verification Form - All Schools
B10 SFA Reimbursement Consolidation and Claim Verification Form - All Schools.docx
Yes
Yes
Fillable Fileable
Other-Appendix B11. SFA Director Survey (web based)
B11 SFA Director Survey (Web Based).docx
Yes
Yes
Fillable Fileable
Other-Appendix B12. SFA Director Interview (by phone)
B12 SFA Director Interview (By Phone).docx
No
Paper Only
Other-Appendix B13. SFA Meal Participation Data Request
B13 SFA Meal Participation Data Request.docx
Yes
Yes
Fillable Fileable
Other-Appendix B14. State Meal Claim Data Request
B14 State Meal Claim Data Request.docx
Yes
Yes
Fillable Fileable
Other-Appendix C1. School Pre-Visit Interview
C01 School Pre-Visit Interview.docx
Yes
No
Fillable Printable
Other-Appendix C3. Meal Transaction Observation Form
C03 Meal Transaction Observation Form.docx
No
Paper Only
Other-Appendix C5. Cafeteria Manager Interview
C05 Cafeteria Manager Interview.docx
No
Paper Only
Other-Appendix C6. School Meal Count Verification Form
C06 School Meal Count Verification Form.docx
No
Paper Only
Other-Appendix O2. Template E-Letter from FNS Regional Liaison to State Child Nutrition Director
O02 Template E-Letter from FNS Regional Liaison to State Child Nutrition Director.docx
Yes
No
Fillable Printable
Other-Appendix O3. State Follow Up Contact Guide
O03 State Follow Up Contact Guide.docx
No
Paper Only
Other-Appendix O4. SFA Study Notification and School Data Verification E-Letter
O04 SFA Study Notification and School Data Verification E-Letter.pdf
Yes
Yes
Fillable Fileable
Other-Appendix O5. SFA Follow Up Contact Guide (Study Notification and School Data Verification)
O05 SFA Follow Up Contact Guide (Study Notification and School Data Verification).docx
Yes
No
Fillable Printable
Other-Appendix O8. SFA School Sample Notification E-Letter
O08 SFA School Sample Notification E-Letter.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Income Security
Subfunction:
Food and Nutrition Assistance
Privacy Act System of Records
Title:
FNS-8 USDA/FNS Studies and Reports
FR Citation:
56 FR 19078
Number of Respondents:
2,801
Number of Respondents for Small Entity:
19
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
21 %
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
10,084
0
10,084
0
0
0
Annual IC Time Burden (Hours)
4,521
0
4,521
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Appendix B6. SFA Data Collection Visit Reminder Email
B06 SFA Data Collection Visit Reminder Email.docx
05/17/2017
Appendix C4. Example of Meal Transaction Sampling
C04 Example of Meal Transaction Sampling 6.20.17.docx
06/20/2017
Appendix C2. School Data Collection Visit Reminder Email
C02 School Data Collection Visit Reminder Email.docx
05/17/2017
Appendix O6. SFA Automated Email - Receipt of Verification of School Data
O06 SFA Automated Email - Receipt of Verification of School Data.docx
05/18/2017
Appendix O7. SFA Confirmation and Next Steps Email
O07 SFA Confirmation and Next Steps Email.docx
05/18/2017
Appendix O9. School Study Notification E-Letter
O09 School Study Notification E-Letter.docx
05/18/2017
Appendix O10. APEC III Fact Sheet (for SFAs and Schools)
O10 APEC III Fact Sheet (For SFAs and Schools).docx
05/18/2017
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.