Change Justification Memo

Memorandum

DATE: December 5, 2008

TO: Stephanie Ward, OMB Desk Officer, Food and Nutrition Service

THROUGH: Rachelle Ragland Greene, Food and Nutrition Service, Information Clearance Officer

FROM: Cindy Long, Director, Child Nutrition Division, Food and Nutrition Service Jane Mandell, Branch Chief, Nutrition Promotion and Technical Assistance, Child Nutrition Division

RE: Under Approved Generic OMB Clearance No. 0584-0524 Request Approval for Application and Enrollment Forms

The Food and Nutrition Service (FNS) of the USDA Food, Nutrition and Consumer Services is requesting approval for formative research under Approved Generic OMB Clearance No. 0584-0524. The following information is provided for your review:

1. Title of Project: Application and Enrollment Forms

2. Clearance Number: 0584-0524

3. Public Affected by this Project: State and local agency program staff, such as school food service directors and other personnel who work with FNS nutrition assistance programs.

4. Number of Respondents: We anticipate that there will be 300 HealthierUS School Challenge applications (Attachments B and C) and 2,000 for Team Nutrition (Attachment A) for a total of 2,300 respondents.

5. Time Needed per Response: For the application form for the HealthierUS School Challenge, approximately three hours is needed for each application form and for a Team Nutrition School, approximately 10 minutes is needed for each enrollment form.

6. Total Burden Hours on the Public: 1233 hours total (900 hours for the HealthierUS School Challenge and 333 hours for Team Nutrition). Each of the web-based forms will display the OMB control number and public burden statement.

FNS requests an exemption from displaying the expiration date on the forms listed in the attachments. This will allow users to continuously apply, as long as the initiatives remain intact. The data from both forms will be used for administrative purposes.

7. Project Purpose, Methodology and Data Collection: The purpose of the data collection is to obtain information from schools regarding their school meal programs and their overall school health environment. Schools that enroll as a Team Nutrition School will receive communications from FNS informing them of new educational and promotional resources targeted for students, educators, and parents that are available from FNS. Schools with exemplary applications for the HealthierUS School Challenge will receive an award to recognize their accomplishments. The Challenge reinforces Section 204 of the Child Nutrition and WIC Reauthorization Act (2004) which requires that all school districts develop a school wellness policy.

Participation in both the HealthierUS School Challenge (HUSSC) and Team Nutrition are completely voluntary in nature and schools interested in submitting an application or enrollment form will do so at their own discretion. To minimize burden for the public, web-based forms will be accessible to the public on the FNS website. Those interested in submitting an enrollment or application form can download them and either mail, email or fax them to a designated address, or fax number. Schools can apply for HUSSC Bronze, Silver, Gold or Gold with Distinction awards. FNS will review information submitted on the HUSSC applications to determine if the applicant meets specific criteria to qualify for an award (certificate and banner). Information from the Team Nutrition School enrollment form will be entered into a database so that the school can receive future nutrition education resources from FNS, free of charge. No compensation will be provided to applicants. The forms will be available as long as the Team Nutrition School and the HealthierUS School Challenge are part of the FNS’ priorities.

8. Federal Costs: $0.00

9. Requested Approval Date: January 2, 2009

10. Attachments:

1. Team Nutrition Enrollment Form (see Attachment A)

2. HealthierUS School Challenge Bronze/Silver Application (see Attachment B)

3. HealthierUS School Challenge Gold/Gold with Distinction Application (see Attachment C)

11. Contact Information: Questions regarding this data collection request can be directed to:

Jan Adams at 703-305-2640 or Nancy Gaston at 703-305-1062.