State Agencies (Prinicpal & Teachers) REV 2

Generic Clearance to Conduct Formative Research

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0524 can be found here:

Documents and Forms

Document Name Document Type
A - Teacher Letter_Survey_Consent Form_FINAL.docx Other-A - Teacher Letter_Survey_Cons
C - Food Service Staff Letter _Survey_Consent Form_FINAL.docx Other-C - Food Service Staff Letter
F - Teacher Post-Survey_FINAL.doc Other-F - Teacher Post-Survey_FINAL
G - Teacher InDepth Interview Guide_FINAL.doc Other-G - Teacher InDepth Interview
I - Food Service Staff Post-Survey_FINAL.docx Other-I - Food Service Staff Post-Su
J - Food Service Staff InDepth Interview Guide_FINAL.doc Other-J - Food Service Staff InDepth
E - Educator Journal _FINAL (2).docx Other-E - Educator Journal _FINAL (2
OMB Package for Pilot Testing_FINAL.doc OMB Package for Pilot Testing_FINAL IC Document
K - Classroom Observation Log_FINAL.docx K - Classroom Observation Log_FINAL IC Document

Information Collection (IC) Details

IC Title:	State Agencies (Prinicpal & Teachers) REV 2	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Electronic Capability
Other-A - Teacher Letter_Survey_Consent Form_FINAL	A - Teacher Letter_Survey_Consent Form_FINAL.docx	No	Paper Only
Other-C - Food Service Staff Letter _Survey_Consent Form_FINAL	C - Food Service Staff Letter _Survey_Consent Form_FINAL.docx	No	Paper Only
Other-F - Teacher Post-Survey_FINAL	F - Teacher Post-Survey_FINAL.doc	No	Paper Only
Other-G - Teacher InDepth Interview Guide_FINAL	G - Teacher InDepth Interview Guide_FINAL.doc	No	Paper Only
Other-I - Food Service Staff Post-Survey_FINAL	I - Food Service Staff Post-Survey_FINAL.docx	No	Paper Only
Other-J - Food Service Staff InDepth Interview Guide_FINAL	J - Food Service Staff InDepth Interview Guide_FINAL.doc	No	Paper Only
Other-E - Educator Journal _FINAL (2)	E - Educator Journal _FINAL (2).docx	No	Paper Only

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 33	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	33	33
Annual IC Time Burden (Hours)	25	25
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
OMB Package for Pilot Testing_FINAL	OMB Package for Pilot Testing_FINAL.doc	08/15/2012
K - Classroom Observation Log_FINAL	K - Classroom Observation Log_FINAL.docx	08/15/2012

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