State/Local: H - School Meal Count Verification Form

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

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

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:

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 %

	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

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.