Fns-248 Status Of Sample Selection And Completion

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OMB 0584-0034 ATTACHMENT B
U.S. DEPARTMENT OF AGRICULTURE - FOOD AND NUTRITION SERVICE

FORM APPROVED OMB. NO. 0584-0034
Expiration Date: XX/XXXX

STATE

FISCAL YEAR

STATUS OF SAMPLE SELECTION
AND COMPLETION

MONTH

FNS HANDBOOK 311
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB
control number. The valid OMB control number for this collection of information is 0584-0034. The time required to complete this information
collection is 0.5472 minutes per response, including the time to review instructions, search existing data resources, gather the data needed and
complete and review the information collection.
STRATUM

1a
I. ACTIVE CASE INFORMATION
A. TOTAL FRAME SIZE
B. TARGET SAMPLE SIZE
C. SAMPLING INTERVAL
D. SAMPLE CASES SELECTED

LINE
NO.
1
2
3
4

B. TARGET SAMPLE SIZE
C. SAMPLING INTERVAL
D. SAMPLE CASES SELECTED
1. Pending
2. Disposed
a. Not Subject to Review
b. Not Completed
c. Completed
1. No Error
2. Error

1b

2a

STRATUM

2b

3a

STRATUM

3b

4a

4b

REPORTING YEAR TO REPORTING YEAR TO REPORTING YEAR TO REPORTING YEAR TO
MONTH
DATE
MONTH
DATE
MONTH
DATE
MONTH
DATE

STRATUM

II. NEGATIVE CASE INFORMATION
A. TOTAL FRAME SIZE

STRATUM

1a

STRATUM

1b

2a

STRATUM

2b

3a

STRATUM

3b

4a

4b

5
6
7
8
9
10
11
12
13
14
15

NOTES:

FORM FNS-248 (06-09) Previous Editions are
Obsolete

SBU

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