Information Collection

NSLP/SBP Access, Participation, Eligibility, and Certification Study

IC 3145 under ICR 201204-0584-007 · OMB 0584-0530.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0530 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
rev062112 Attachment C.1-SFA District Director Questionnaire.doc	Other-Attachment C.1-SFA District Di
rev062112 Attachment D.1-SFA Reimbursement Claim Verif Form-Month.doc	Other-Attachment D.1-SFA Reimburseme
rev062112 Attachment D.2-SFA Reimbursement Claim Verif Form-Week.doc	Other-Attachment D.2-SFA Reimburseme
rev062112 Attachment D.3-SFA Reimbursement Claim Verif Form-For All Schools.doc	Other-Attachment D.3-SFA Reimburseme
rev062112 Attachment E.1-Application Data Abstraction Form.doc	Other-Attachment E.1-Application Dat
rev062112 Attachment F.1-Student Sample Contact Info Form.docm	Other-Attachment F.1-Student Sample
rev062112 Attachment F.2-Newly Cert FRP.doc	Other-Attachment F.2-Newly Cert FRP
rev062112 Attachment H.1-School Meal Count Form-Day.doc	Other-Attachment H.1-School Meal Cou
rev062112 Attachment H.2-School Meal Count Form-Week.doc	Other-Attachment H.2-School Meal Cou
rev062112 Attachment H.3-School Meal Count Verification Form-Target Month.doc	Other-Attachment H.3-School Meal Cou
rev062112 Attachment H.4-Supplemental Reporting Form (for Sampled School).doc	Other-Attachment H.4-Supplemental Re
rev062112 Attachment O.3-Administrative Data Items Being Rqst from State Agencies.doc	Other-Attachment O.3-Administrative
rev062112 Attachment G.1-CEO Student Sampling File Documentation Form.doc	Other-Attachment G.1-CEO Student Sam
rev062112 Attachment I.1-Meal Transaction Observation Form - For All Schools.doc	Other-Attachment I.1-Meal Transactio
rev062112 Attachment I.2-Meal Transaction Observation Form - For All Schools.doc	Other-Attachment I.2-Meal Transactio
rev062112 Attachment J.1-Changes in Student Certification and Enrollment Form - For All Schools.doc	Other-Attachment J.1-Changes in Stud
rev062112 Attachment K.1-Participation Data Protocol- For All Schools.doc	Other-Attachment K.1-Participation D
rev062112 Attachment B.1-Superintendent Letter.docx Attachment B.1-Superintendent Letter	IC Document
rev062112 Attachment B.2-SFA Letter.docx Attachment B.2-SFA Letter	IC Document
rev062112 Attachment B.3-Study Overview.docx Attachment B.3-Study Overview	IC Document
rev062112 Attachment B.4-Suggested Text for Recruiting Call.docx Attachment B.4-Suggested Text for Recruiting Call	IC Document
rev062112 Attachment B.5-Initial Email to SFA Directors.docx Attachment B.5-Initial Email to SFA Directors	IC Document
rev062112 Attachment B.6-Reminder Email to SFA Directors.docx Attachment B.6-Reminder Email to SFA Directors	IC Document
rev062112 Attachment O.1-Advance Letter to State.doc Attachment O.1-Advance Letter to State	IC Document
rev062112 Attachment O.2-State Agency Director Protocol.doc Attachment O.2-State Agency Director Protocol	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

NSLP/SBP Access, Participation, Eligibility, and Certification Study

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	Available Electronically?	Electronic Capability
Other-Attachment C.1-SFA District Director Questionnaire	rev062112 Attachment C.1-SFA District Director Questionnaire.doc	No	Paper Only
Other-Attachment D.1-SFA Reimbursement Claim Verif Form-Month	rev062112 Attachment D.1-SFA Reimbursement Claim Verif Form-Month.doc	No	Paper Only
Other-Attachment D.2-SFA Reimbursement Claim Verif Form-Week	rev062112 Attachment D.2-SFA Reimbursement Claim Verif Form-Week.doc	No	Paper Only
Other-Attachment D.3-SFA Reimbursement Claim Verif Form-For All Schools	rev062112 Attachment D.3-SFA Reimbursement Claim Verif Form-For All Schools.doc	No	Paper Only
Other-Attachment E.1-Application Data Abstraction Form	rev062112 Attachment E.1-Application Data Abstraction Form.doc	No	Paper Only
Other-Attachment F.1-Student Sample Contact Info Form	rev062112 Attachment F.1-Student Sample Contact Info Form.docm	No	Paper Only
Other-Attachment F.2-Newly Cert FRP	rev062112 Attachment F.2-Newly Cert FRP.doc	No	Paper Only
Other-Attachment H.1-School Meal Count Form-Day	rev062112 Attachment H.1-School Meal Count Form-Day.doc	No	Paper Only
Other-Attachment H.2-School Meal Count Form-Week	rev062112 Attachment H.2-School Meal Count Form-Week.doc	No	Paper Only
Other-Attachment H.3-School Meal Count Verification Form-Target Month	rev062112 Attachment H.3-School Meal Count Verification Form-Target Month.doc	No	Paper Only
Other-Attachment H.4-Supplemental Reporting Form (for Sampled School)	rev062112 Attachment H.4-Supplemental Reporting Form (for Sampled School).doc	No	Paper Only
Other-Attachment O.3-Administrative Data Items Being Rqst from State Agencies	rev062112 Attachment O.3-Administrative Data Items Being Rqst from State Agencies.doc	No	Paper Only
Other-Attachment G.1-CEO Student Sampling File Documentation Form	rev062112 Attachment G.1-CEO Student Sampling File Documentation Form.doc	No	Paper Only
Other-Attachment I.1-Meal Transaction Observation Form	rev062112 Attachment I.1-Meal Transaction Observation Form - For All Schools.doc	No	Paper Only
Other-Attachment I.2-Meal Transaction Observation Form	rev062112 Attachment I.2-Meal Transaction Observation Form - For All Schools.doc	No	Paper Only
Other-Attachment J.1-Changes in Student Certification and Enrollment Form	rev062112 Attachment J.1-Changes in Student Certification and Enrollment Form - For All Schools.doc	No	Paper Only
Other-Attachment K.1-Participation Data Protocol	rev062112 Attachment K.1-Participation Data Protocol- For All Schools.doc	No	Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records

Title: FNS-8 USDA/FNS Studies and Reports

FR Citation: 65 FR 63

Number of Respondents: 2,436

Number of Respondents for Small Entity: 236

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,944	2,944
Annual IC Time Burden (Hours)	2,156	2,156
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment B.1-Superintendent Letter	rev062112 Attachment B.1-Superintendent Letter.docx	06/27/2012
Attachment B.2-SFA Letter	rev062112 Attachment B.2-SFA Letter.docx	06/27/2012
Attachment B.3-Study Overview	rev062112 Attachment B.3-Study Overview.docx	06/27/2012
Attachment B.4-Suggested Text for Recruiting Call	rev062112 Attachment B.4-Suggested Text for Recruiting Call.docx	06/27/2012
Attachment B.5-Initial Email to SFA Directors	rev062112 Attachment B.5-Initial Email to SFA Directors.docx	06/27/2012
Attachment B.6-Reminder Email to SFA Directors	rev062112 Attachment B.6-Reminder Email to SFA Directors.docx	06/27/2012
Attachment O.1-Advance Letter to State	rev062112 Attachment O.1-Advance Letter to State.doc	06/27/2012
Attachment O.2-State Agency Director Protocol	rev062112 Attachment O.2-State Agency Director Protocol.doc	06/27/2012

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