Monthly Claim for Reimbursement

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form FNS 806-B Monthly Claim for Reimbursement FNS 806-A & B	Form and Instruction	Modified	Available
#0584-0284 Supporting Statement REV 1-12-07.doc	Supporting Statement A	Uploaded 2007-02-13	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
3005	Monthly Claim for Reimbursement FNS 806-A & B	Form and Instruction	Modified

ICR Details

OMB Control No: 0584-0284	ICR Reference No: 200609-0584-013
Status: Historical Active	Previous ICR Reference No: 200308-0584-002
Agency/Subagency: USDA/FNS	Agency Tracking No:
Title: Monthly Claim for Reimbursement
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 02/15/2007
	Date Received in OIRA: 11/28/2006
Terms of Clearance: This ICR is approved consistent with 2/12/07 memo and with the understanding that FNS will modify the time estimate in the PRA blurb on the paper-based version of these forms (to reflect the original 0.75 hour estimate).

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2010	36 Months From Approved	02/28/2007
Responses	2,730	0	2,090
Time Burden (Hours)	1,896	0	1,735
Cost Burden (Dollars)	0	0	0

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Abstract: These forms are used by school food authorities who participate in the National School Lunch Program, School Breakfast Program, and Special Milk Program that are administered by the FNS regional offices. The data is used to determine the amount of reimbursement for meals and milk served.

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Authorizing Statute(s): PL: Pub.L. 109 - 85 4 Name of Law: Child Nutrition Act of 1966
   PL: Pub.L. 109 - 97 3 Name of Law: Richard B. Russell National School Lunch Act
   PL: Pub.L. 109 - 85 3(a)(10) Name of Law: Child Nutrition Act of 1966
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 40988	07/19/2006
30-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 228	11/28/2006
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Monthly Claim for Reimbursement FNS 806-A & B	FNS 806-B, FNS 806-A (Electronic), FNS 806-B, FNS 806-A	Milk Claim for Reimbursement ,   Milk Claim for Reimbursement ,   School Lunch/Breakfast/Snack Claim for Reimbursement ,   School Lunch/Breakfast/Snack Claim for Reimbursement

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	2,730	2,090	0	0	640	0
Annual Time Burden (Hours)	1,896	1,735	0	0	161	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The total burden requested for this collection is 1,896. This is an increase of 161 hours from the previously approved inventory of 1,735. The time needed to complete the electronic form has decreased from .75 of an hour per response to .50 of an hour (60% of the responses); the number of respondents has increased from 209 to 273 due to the increase in the number of school food authorities participating in the programs administer by the regional offices. With the increase in the number of respondents, thus recordkeeping burden previously identified as 167 hours increases to 218 hours. Therefore, the increase of 161 hours to the previously approved 1,735 hours, to the requested burden for this collection of 1,896, is due to an adjustment.

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Annual Cost to Federal Government: $18,276

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 11/28/2006

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