CACFP National Disqualified List - Forms FNS-843, FNS-844

Forms and Documents

Document Name	Status
Form FNS-843 FNS-843, FNS 844 Form and Instruction	New
061813 Supporting Statement for NDL Forms.docx Supporting Statement A	2013-06-18

IC Document Collections

IC ID	Document Title	Status
206841	FNS-843, FNS 844 Form and Instruction	New

ICR Details

OMB Control No: 0584-0584	ICR Reference No: 201305-0584-002
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: USDA/FNS	Agency Tracking No:
Title: CACFP National Disqualified List - Forms FNS-843, FNS-844
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/06/2013
	Date Received in OIRA: 06/18/2013
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2016	36 Months From Approved
Responses	1,568	0	0
Time Burden (Hours)	784	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Maintains National Disqualified List (NDL) of institutions, day care home providers, and individuals that have been terminated or otherwise disqualified from CACFP participation. State agencies will be required to enter data as institutions and individuals become disqualified from participation.

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Authorizing Statute(s): US Code: 42 USC 1766 Name of Law: Richard B. Russell National School Lunch Act (NSLA)
   PL: Pub.L. 106 - 224 243(c) Name of Law: Agricultural Risk Protection Act of 2000
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 14764	03/07/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 115	06/14/2013
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
FNS-843, FNS 844	FNS-844, FNS-844 (online), FNS-843, FNS-843 (online)	Report of Disqualification from Participation-Institutions and Responsible Principals/Individuals ,   NDL Add DQ Institution Screen - FNS-843 ,   Report of Disqualification from Participation-Individually Disqualified Responsible Principal/Individual or Day Care Home Provider ,   NDL Add DQ Individual Screen - FNS-844

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	1,568	0	0	1,568	0	0
Annual Time Burden (Hours)	784	0	0	784	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new collection. The new collection is the result of program changes by FNS to implement a web-based system in which State agencies will update and maintain the list of disqualified institutions and individuals. As a result of program changes, this collection will add 784 burden hours for CACFP reporting in the OMB information collection inventory.

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Annual Cost to Federal Government: $6,153

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 06/18/2013

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