View Information Collection (IC)
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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
State, Local, and Tribal Government (CN Agency Staff, State Medicaid Agency Staff, Other State Agency Staff, and School District Staff)
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 A-2 Site Visit Scheduling Call Protocol
A2 DCM-FRP Site Visit Scheduling Call.docx
No
Paper Only
Other-Appendix A-3a Detailed Site Visit Interview Protocol: State Child Nutrition Agency Staff
A3a DCM-FRP CN Site Visit Protocol.docx
No
Paper Only
Other-Appendix A-3.b Detailed Site Visit Interview Protocol: State Medicaid Agency Staff
A3b DCM-FRP Medicaid Site Visit Protocol.docx
No
Paper Only
Other-Appendix A-3.c Detailed Site Visit Interview Protocol: District Staff
A3c DCM-FRP District Site Visit Protocol.docx
No
Paper Only
Other-Appendix A-4 Site Visit Observation Protocol
A4 DCM-FRP Site Visit Observation Protocol.docx
No
Paper Only
Other-Appendix A.6a Detailed Follow-Up Telephone Interview Protocol: State Child Nutrition Agency Staff
A6a DCM-FRP CN FollowUp Protocol.docx
No
Paper Only
Other-Appendix A-6.b Detailed Follow-Up Telephone Interview Protocol: State Medicaid Agency Staff
A6b DCM-FRP Medicaid FollowUp Protocol.docx
No
Paper Only
Other-Appendix A-6.c Detailed Follow-Up Telephone Interview Protocol: District Staff
A6c DCM-FRP District FollowUp Protocol.docx
No
Paper Only
Other-Appendix B.2 Administrative Records Request
B2 DCM-FRP Admin Records Request.docx
Yes
No
Fillable Printable
Other-Appendix C-2 Instructions for State Cost Data Tracking Logs
C2 DCM-FRP Cost Log Instructions.docx
Yes
No
Fillable Printable
Other-Appendix C-3.a State Cost Data Tracking Logs
C3a DCM-FRP CN Cost Log.xlsx
Yes
No
Fillable Printable
Other-Appendix C-3.b Medicaid State Cost Data Tracking Logs
C3b DCM-FRP Medicaid Cost Log.xlsx
Yes
No
Fillable Printable
Other-Appendix C-4 Semi-Structured State Cost Log Clarification Protocol Questions
C4 DCM-FRP Cost Log Clarification Protocol.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:
FNS-8 USDA/FNS Studies and Reports
FR Citation:
56 FR 19078
Number of Respondents:
195
Number of Respondents for Small Entity:
96
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
1,088
0
1,088
0
0
0
Annual IC Time Burden (Hours)
1,169
0
1,169
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Appendix A.1 Site Visit Letter
A1 DCM-FRP_Site Visit Intro Letter.docx
06/16/2017
Appendix A-2.a Site Visit Preparation: State Child Nutrition Agency
A2a Site Visit Materials_CN agency.docx
06/16/2017
Appendix A-2.b Site Visit Preparation: State Medicaid Agency
A2b Site Visit Materials_Medicaid agency.docx
06/16/2017
Appendix A-2.c Site Visit Preparation: District
A2c Site Visit Materials_District.docx
06/16/2017
Appendix A.5 Site Visit Follow Up Telephone Interview Email
A5 DCM-FRP Site Visit Follow Up Phone Interview Email.docx
06/16/2017
Appendix B.1 Administrative Records Request Emails
B1 DCM-FRP Admin Records Request Emails.docx
06/16/2017
Appendix C-1 State Cost Log Emails
C1 DCM-FRP Cost Log Emails.docx
06/16/2017
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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