Information Collection

State Agencies (Prinicpal & Teachers) REV 2

IC 203722 under ICR 201207-0584-007 · OMB 0584-0524.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

IC Title:

State Agencies (Prinicpal & Teachers) REV 2

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.