Form FNS-248 Status of Sample Selection and Completion

FORM APPROVED OMB NO. 0584-0034
U.S. DEPARTMENT OF AGRICULTURE - FOOD AND NUTRITION SERVICE

STATE

FISCAL YEAR

STATUS OF SAMPLE SELECTION
AND COMPLETION

MONTH

FNS HANDBOOK 311
According to the Paperw ork Reduction Act of 1995, no persons are required to resond to a collection of information unless it displays a valid
OMB control number. The valid OMB control number for this information collection is 0584-0034. The time required to complete this
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maintaining the data needed, and completing and review ing the collection of information.
STRATUM

1a
I.

ACTIVE CASE INFORMATION
A. TOTAL FRAME SIZE
B. TARGET SAMPLE SIZE
C. SAMPLING INTERVAL
D. SAMPLE CASES SELECTED

LINE
NO.
1

REPORTING
MONTH

STRATUM

1b
YEAR TO
DATE

II. NEGATIVE CASE INFORMATION

1a

A. TOTAL FRAME SIZE

5

B. TARGET SAMPLE SIZE

6
7

D. SAMPLE CASES SEELECTED

b. Not Completed

8
9
10
11
12

c. Completed

13

1. Pending
2. Disposed
a. Not Subject to Review

1. No Error
2. Error

2b

REPORTING
MONTH

YEAR TO
DATE

3a
REPORTING
MONTH

3b

4a

4b

YEAR TO
DATE

REPORTING
MONTH

YEAR TO
DATE

2
3
4
STRATUM

C. SAMPLING INTERVAL

2a

STRATUM

STRATUM

STRATUM

1b

2a

STRATUM

STRATUM

2b

3a

3b

4a

4b

14
15

NOTES:

FORM FNS-248 (11-89) Previous edition obsolete

Electronic Form Version Designed in JetForm 5.01 Version