Information Collection

State/Local: H - School Meal Count Verification Form

IC 203784 under ICR 201208-0584-008 · 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⚠️ Notice: This information collection may be referencing outdated material.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 H.1-School Meal Count Form-Day.doc	Other-H.1-School Meal Count Form-Day
rev062112 Attachment H.2-School Meal Count Form-Week.doc	Other-H.2-School Meal Count Form-Wee
rev062112 Attachment H.3-School Meal Count Verification Form-Target Month.doc	Other-H.3-School Meal Count Verifica
rev062112 Attachment H.4-Supplemental Reporting Form (for Sampled School).doc	Other-H.4-Supplemental Reporting For

IC Title:

State/Local: H - School Meal Count Verification Form

Agency IC Tracking Number:

Is this a Common Form? No

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-H.1-School Meal Count Form-Day	rev062112 Attachment H.1-School Meal Count Form-Day.doc	No	Paper Only
Other-H.2-School Meal Count Form-Week	rev062112 Attachment H.2-School Meal Count Form-Week.doc	No	Paper Only
Other-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-H.4-Supplemental Reporting Form (for Sampled School)	rev062112 Attachment H.4-Supplemental Reporting Form (for Sampled School).doc	No	Paper Only

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 429

Number of Respondents for Small Entity: 43

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	429	429
Annual IC Time Burden (Hours)	429	429
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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