Business (Sponsors and sites)

Cost Instrument - Extended (Demonstration Sponsors)

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OMB Control # 0584-NEW

Expiration Date: xx/xx/20xx

Public reporting burden for this collection of information is estimated to average 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: U.S. Department of Agriculture, Food and Nutrition Services, Office of Research and Analysis, 3101 Park Center Drive, Room 1014, Alexandria, VA 22302 ATTN: PRA (0584-xxxx*). Do not return the completed form to this address.

COST DATA COLLECTION INSTRUMENT

Sponsor Level Instrument

Dear [put Full name here]:

As you know, the US Department of Agriculture, Food and Nutrition Services (FNS) is funding demonstration projects to test ideas for reaching greater numbers of children in the summer and making sure that they do not go hungry. FNS has asked Westat to conduct an evaluation of these demonstrations to understand how these ideas are working and how they are carried out. All of the information we collect is meant to provide FNS with valid and objective findings to help them with their policymaking on Federal summer programs.

One of the objectives of this evaluation is to determine and document the total and component costs of implementing and operating the demonstrations, including information on administrative startup costs, ongoing administrative costs of operation, and benefit costs.

As the [position/title] of this sponsor agency, you are an important source of information regarding the costs. For this study, our goal is to identify all the resources used in grant activities.

Below you will find your username and a link to the cost data collection questionnaire. To complete the questionnaire, please click on the following link: add final link here. We ask that you complete the questionnaire by xx/xx/ 2011.


Login page: |LINK1|

Username: |UDF0|

Password: [insert PASSWORD column here].

If you have any problems with this link or username, or if you have any problems with the online questionnaire, please send an email to:[email protected].

If you have any questions regarding the content of the survey, please contact Mustafa Karakus ([email protected] or 1-800-937-8281, extension 2874) or Lynn Elinson ([email protected] or 412 421-8610) from Westat. IF YOU WOULD PREFER TO COMPLETE THIS QUESTIONNAIRE BY HAND, PLEASE LET US KNOW.

We appreciate you taking the time to complete this questionnaire.

Sincerely,

Mustafa Karakus, Ph.D.

Senior Economist

Initial set-up Costs

List all expenditures and source of funding related to resources and staff hours required to set-up the summer demonstration projects.

Type of resources	Expenditures	Source of funding

Ongoing Costs

1. Personnel expenditures

List all salaried personnel; include percentage of time devoted to the program, monthly salary and source of funding. Also include the list of unpaid volunteer staff and their average monthly hours of service.

Title	% of time devoted to the demo	Monthly salary	Source of funding

Volunteers	Number of hours worked in a month

2. Cost of Contracted Services

List all expenses and sources of funding for all contracted services such as food preparation, repairs, maintenance, security services, housekeeping, advertising, consultants, and any other services needed for the program including the in-kind services.

Contracted service	Expenditures	Source of funding

2. Food Benefit and Transportation Costs

List all expenses and source of funding for food benefits (e.g., cost of food items in backpack).

Contracted service	Expenditures	Source of funding

List all expenses associated with food delivery services (e.g., gas, vehicle insurance, etc.).

Contracted service	Expenditures	Source of funding

2. Building and facilities

List all expenses and source of funding for annual lease/rent for the building and facilities used by the summer demonstration project. If the facilities are owned, provide estimated fair market lease or rental price. Also include the percentage of time used for the demonstration program services.

Facility	% of time used	Annual lease/rent value	Source of funding

2. Other Equipment/supplies/materials

List all expenses and sources of funding for purchased/leased/rented equipments, supplies (e.g., backpacks, napkins, utensils, office supplies, housekeeping items, etc.) and materials. Provide market value of supplies and materials that were donated or received free of charge.

Equipment / supplies / materials	Expenditures	Source of funding

2. Administrative and operational overhead

List all expenses and source of funding for expenses related to administrative and operational overhead, (e.g., electricity, gas, oil, water and sewer, garbage, insurance, licenses, taxes, telephone, books, subscriptions, regulation fees, travel and other miscellaneous items)

Administrative and operational	Expenditures	Source of funding

If you are not able to itemize and/or provide dollar value for the overhead expenditures, you can also provide the rate for overhead expenses as a percentage of all other expenses.

Administrative and operational	% of all other expenses	Source of funding

2. Other costs

List all other expenses and source of funding for resources and miscellaneous items that are not included in items 1 through 6 above.

Other resources	Expenditures	Source of funding

1