State and Local Governments

The Evaluation of Demonstrations of NSLP/SBP Direct Certification of Children Receiving Medicaid Benefits

OMB: 0584-0586

IC ID: 206968

Documents and Forms
Document Name
Document Type
Other-CERTIFICATION AND PARTICIPATIO
Other-Certification and Participatio
Other-Cost Survey Tracking Log (Chil
Other-Cost Survey Tracking Log (Medi
Other-State Cost Survey Follow Up In
Other-State Cost Survey Follow Up In
Other-State Cost Survey Introductory
Other-State Cost Survey Letter 1st Q
Other-State Cost Survey Letter 2nd-4
Other-State Cost Survey Letter 1st Q
Other-State Cost Survey Letter 2nd-4
Other-State Cost Survey Follow Up In
Other-Sample DC-M1 State Letter/Emai
Other-Sample DC-M2 State Letter/Emai
Other-Sample State Letter/Email to C
Other-District Cost Survey - Summer
Other-District Cost Survey – SY 2013
Other-District Cost Survey Advance L
Other-District Cost Survey Follow-Up
Other-State Challenge Interview Prot
Other-State Challenge Interview Prot
Other-District Challenge Interview P
Other-State Challenge Interview Prot
Other-State Challenge Interview Prot
Other-District Challenge Interview P
Other-State Challenge Interview Lett
Other-District Challenge Interview L
Other-State Challenge Interview Sche
Other-District Challenge Interview S
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

State and Local Governments
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL 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 – 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

Income Security Food and Nutrition Assistance

FNS-8 USDA/FNS Studies and Reports  56 FR 19078

1,087 816
   
State, Local, and Tribal Governments
 
   99 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 5,394 0 -1,405 0 0 6,799
Annual IC Time Burden (Hours) 2,769 0 -351 0 0 3,120
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.
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