Information Collection

State and Local Governments

IC 206968 under ICR 201305-0584-004 · OMB 0584-0586.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0586 can be found here:

2013-11-13 - No material or nonsubstantive change to a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appendix A.1 (5-6-13).docx	Other-CERTIFICATION AND PARTICIPATIO
Appendix A.2 (5-6-13).docx	Other-Certification and Participatio
Appendix B.1 (5-6-13).docx	Other-Cost Survey Tracking Log (Chil
Appendix B.2 (5-6-13).docx	Other-Cost Survey Tracking Log (Medi
Appendix C.1 (5-28-13).docx	Other-State Cost Survey Follow Up In
Appendix C.2 (5-28-13).docx	Other-State Cost Survey Follow Up In
Appendix D.1 (5-6-13).docx	Other-State Cost Survey Introductory
Appendix D.2 (5-6-13).docx	Other-State Cost Survey Letter 1st Q
Appendix D.3 (5-6-13).docx	Other-State Cost Survey Letter 2nd-4
Appendix D.4 (5-6-13).docx	Other-State Cost Survey Letter 1st Q
Appendix D.5 (5-6-13).docx	Other-State Cost Survey Letter 2nd-4
Appendix D.6 (5-6-13).docx	Other-State Cost Survey Follow Up In
Appendix E.1 (5-6-13).docx	Other-Sample DC-M1 State Letter/Emai
Appendix E.2 (5-6-13).docx	Other-Sample DC-M2 State Letter/Emai
Appendix E.3 (5-6-13).docx	Other-Sample State Letter/Email to C
Appendix F.1 (5-6-13).docx	Other-District Cost Survey - Summer
Appendix F.2 (5-10-13).docx	Other-District Cost Survey – SY 2013
Appendix G.1 (5-6-13).docx	Other-District Cost Survey Advance L
Appendix G.2 (5-6-13).docx	Other-District Cost Survey Follow-Up
Appendix H.1 (5-28-13).docx	Other-State Challenge Interview Prot
Appendix H.2 (5-28-13).docx	Other-State Challenge Interview Prot
Appendix H.3 (5-28-13).docx	Other-District Challenge Interview P
Appendix H.4 (5-28-13).docx	Other-State Challenge Interview Prot
Appendix H.5 (5-28-13).docx	Other-State Challenge Interview Prot
Appendix H.6 (5-28-13).docx	Other-District Challenge Interview P
Appendix I.1 (5-6-13).docx	Other-State Challenge Interview Lett
Appendix I.2 (5-6-13).docx	Other-District Challenge Interview L
Appendix I.3 (5-8-13).docx	Other-State Challenge Interview Sche
Appendix I.4 (5-8-13).docx	Other-District Challenge Interview S
Appendix A-CP.docx Appendix A-CP	IC Document
Appendix B-CP.docx Appendix B-CP	IC Document
Appendix C-CP.docx Appendix C-CP	IC Document
Appendix D-CP.docx Appendix D-CP	IC Document
Appendix E-CP (5-6-13).docx Appendix E-CP	IC Document
Appendix F-CP.docx Appendix F-CP	IC Document
Appendix F.3 (5-20-13).docx Appendix F.3 Screen Shots	IC Document
Appendix G-CP.docx Appendix G-CP	IC Document
Appendix H-CP.docx Appendix H-CP	IC Document
Appendix I-CP.docx Appendix I-CP	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

State and Local Governments

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?	Can Be Submitted Electronically?	Electronic Capability
Other-CERTIFICATION AND PARTICIPATION DATA REQUEST	Appendix A.1 (5-6-13).docx	No		Paper Only
Other-Certification and Participation Data Request Email	Appendix A.2 (5-6-13).docx	Yes	Yes	Fillable Fileable
Other-Cost Survey Tracking Log (Child Nutrition Agency Version)	Appendix B.1 (5-6-13).docx	Yes	Yes	Fillable Fileable
Other-Cost Survey Tracking Log (Medicaid Agency Version)	Appendix B.2 (5-6-13).docx	Yes	Yes	Fillable Fileable
Other-State Cost Survey Follow Up Interview Protocol	Appendix C.1 (5-28-13).docx	Yes	Yes	Fillable Fileable
Other-State Cost Survey Follow Up Interview Protocol	Appendix C.2 (5-28-13).docx	Yes	Yes	Fillable Fileable
Other-State Cost Survey Introductory Email	Appendix D.1 (5-6-13).docx	Yes	Yes	Fillable Fileable
Other-State Cost Survey Letter 1st Quarter (Child Nutrition Agency Version)	Appendix D.2 (5-6-13).docx	No		Paper Only
Other-State Cost Survey Letter 2nd-4th Quarters (Child Nutrition Agency Version)	Appendix D.3 (5-6-13).docx	No		Paper Only
Other-State Cost Survey Letter 1st Quarter (Medicaid Agency Version)	Appendix D.4 (5-6-13).docx	No		Paper Only
Other-State Cost Survey Letter 2nd-4th Quarters (Medicaid Agency Version)	Appendix D.5 (5-6-13).docx	No		Paper Only
Other-State Cost Survey Follow Up Interview Email	Appendix D.6 (5-6-13).docx	Yes	Yes	Fillable Fileable
Other-Sample DC-M1 State Letter/Email to Demonstration LEAs Informing them of the Study	Appendix E.1 (5-6-13).docx	Yes	Yes	Fillable Fileable
Other-Sample DC-M2 State Letter/Email for Demonstration LEAs Informing them of the Study	Appendix E.2 (5-6-13).docx	Yes	Yes	Fillable Fileable
Other-Sample State Letter/Email to Control LEAs Informing Them of the Study	Appendix E.3 (5-6-13).docx	Yes	Yes	Fillable Fileable
Other-District Cost Survey - Summer 2013 (Retrospective)	Appendix F.1 (5-6-13).docx	Yes	Yes	Fillable Fileable
Other-District Cost Survey â SY 2013-2014	Appendix F.2 (5-10-13).docx	Yes	Yes	Fillable Fileable
Other-District Cost Survey Advance Letter	Appendix G.1 (5-6-13).docx	No		Paper Only
Other-District Cost Survey Follow-Up Email	Appendix G.2 (5-6-13).docx	Yes	Yes	Fillable Fileable
Other-State Challenge Interview Protocol	Appendix H.1 (5-28-13).docx	No		Paper Only
Other-State Challenge Interview Protocol	Appendix H.2 (5-28-13).docx	No		Paper Only
Other-District Challenge Interview Protocol	Appendix H.3 (5-28-13).docx	No		Paper Only
Other-State Challenge Interview Protocol	Appendix H.4 (5-28-13).docx	No		Paper Only
Other-State Challenge Interview Protocol	Appendix H.5 (5-28-13).docx	No		Paper Only
Other-District Challenge Interview Protocol	Appendix H.6 (5-28-13).docx	No		Paper Only
Other-State Challenge Interview Letter (Child Nutrition/Medicaid Version)	Appendix I.1 (5-6-13).docx	No		Paper Only
Other-District Challenge Interview Letter	Appendix I.2 (5-6-13).docx	No		Paper Only
Other-State Challenge Interview Scheduling Call Script	Appendix I.3 (5-8-13).docx	No		Paper Only
Other-District Challenge Interview Scheduling Call Script	Appendix I.4 (5-8-13).docx	No		Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records

Title: FNS-8 USDA/FNS Studies and Reports

FR Citation: 56 FR 19078

Number of Respondents: 1,087

Number of Respondents for Small Entity: 816

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 99 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	6,799	6,799
Annual IC Time Burden (Hours)	3,120	3,120
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Appendix A-CP	Appendix A-CP.docx	05/23/2013
Appendix B-CP	Appendix B-CP.docx	05/23/2013
Appendix C-CP	Appendix C-CP.docx	05/23/2013
Appendix D-CP	Appendix D-CP.docx	05/23/2013
Appendix E-CP	Appendix E-CP (5-6-13).docx	05/23/2013
Appendix F-CP	Appendix F-CP.docx	05/23/2013
Appendix F.3 Screen Shots	Appendix F.3 (5-20-13).docx	05/23/2013
Appendix G-CP	Appendix G-CP.docx	05/23/2013
Appendix H-CP	Appendix H-CP.docx	05/23/2013
Appendix I-CP	Appendix I-CP.docx	05/23/2013

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