Information Collection

School Nutrition Dietary Assessment Study - IV

IC 3142 under ICR 200902-0584-001 · OMB 0584-0527.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appendix H Principal Survey.doc Not Yet Available	Other-Principal Survey
Appendix C.doc	Other-Menu Survey Forms
Appendix G.doc	Other-School Food Service Manager Su
School Food Autority Director Survey.doc Not Yet Available	Other-SFA Director Survey
Appendix D Menu Survey Instructions.doc	Instruction
Appendix E.docx Appendix E- Procedures for Menu Survey Training	IC Document
Appendix H Cover and Email Communications with Principals.doc Appendix H - Cover and Email Communication	IC Document
Appendix J Cover and Email Communications with SFA Directors.doc Appendix J - Advance Letters and Other Communication	IC Document
Cover page attached Training Module for School Liaison Who.pptm Appendix K - Training Module for School Liaison _Competitive Food Checklist	IC Document
Appendix D Daily Reminder List.doc Appendix D - Daily Reminder List	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Principal Survey	Appendix H Principal Survey.doc	Not Yet Available	Yes	Yes	Fillable Fileable Signable
Other-Menu Survey Forms	Appendix C.doc		No		Paper Only
Other-School Food Service Manager Survey	Appendix G.doc		No		Paper Only
Other-SFA Director Survey	School Food Autority Director Survey.doc	Not Yet Available	Yes	Yes	Fillable Fileable Signable
Instruction	Appendix D Menu Survey Instructions.doc		No		Paper Only

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3,725

Number of Respondents for Small Entity: 300

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 60 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3,725	3,725
Annual IC Time Burden (Hours)	7,111	7,111
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Appendix E- Procedures for Menu Survey Training	Appendix E.docx	06/18/2009
Appendix H - Cover and Email Communication	Appendix H Cover and Email Communications with Principals.doc	06/18/2009
Appendix J - Advance Letters and Other Communication	Appendix J Cover and Email Communications with SFA Directors.doc	06/18/2009
Appendix K - Training Module for School Liaison _Competitive Food Checklist	Cover page attached Training Module for School Liaison Who.pptm	06/18/2009
Appendix D - Daily Reminder List	Appendix D Daily Reminder List.doc	06/18/2009

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.