Information Collection

SNMCS Individuals

IC 211124 under ICR 201404-0584-003 · OMB 0584-0596.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
N1. Child's Food Diary, Day 1 and Day 2.docx	Other-N1. Child's Food Diary, Day 1
N2. Child's Food Diary, Day 1 and Day 2 (Spanish).docx	Other-N2. Child's Food Diary, Day 1
N3. Child-Youth Interview (In-Person Interview).docx	Other-N3. Child-Youth Interview (In-
N4. Child-Youth Interview (In-Person Interview) (Spanish).docx	Other-N4. Child-Youth Interview (In-
N5. Parent Interview (In-Person or Telephone Interview) 2014.04.02.docx	Other-N5. Parent Interview (In-Perso
N6 Parent Interview (In-Person or Telephone Interview) (Spanish) (2).docx	Other-N6 Parent Interview (In-Person
N7. Automated Multiple Pass Method (AMPM).docx	Other-N7. Automated Multiple Pass Me
O. Student Height and Weight Measurement Form.docx	Other-O. Student Height and Weight M
L1. School Endorsement Letter.docx L1. School Endorsement Letter	IC Document
L2. School Endorsement Letter (Spanish).docx L2. School Endorsement Letter (Spanish)	IC Document
L3. Elementary School Parent (Household) Advance Letter.docx L3. Elementary School Parent (Household) Advance Letter	IC Document
L4. Elementary School Parent (Household) Advance Letter (Spanish).docx L4. Elementary School Parent (Household) Advance Letter (Spanish)	IC Document
L5. Household Elementary Brochure 2014.04.01.docx L5. Household Elementary Brochure 2014.04.01	IC Document
L6. Household Elementary Brochure (Spanish) 2014.04.01.docx L6. Household Elementary Brochure (Spanish) 2014.04.01	IC Document
L7. Middle and High School Parent (Household) Advance Letter.docx L7. Middle and High School Parent (Household) Advance Letter	IC Document
L8. Middle and High School Parent (Household) Advance Letter (Spanish).docx L8. Middle and High School Parent (Household) Advance Letter (Spanish)	IC Document
L9. Household Middle and High School Brochure 2014.04.01.docx L9. Household Middle and High School Brochure 2014.04.01	IC Document
L10. Household Middle and High School Brochure (Spanish) 2014.04.01.docx L10. Household Middle and High School Brochure (Spanish) 2014.04.01	IC Document
L11. Facebook Page Screen Shot.png L11. Facebook Page Screen Shot	IC Document
M1. Parent Passive Consent Response Form.docx M1. Parent Passive Consent Response Form	IC Document
M2. Parent Passive Consent Response Form (Spanish).docx M2. Parent Passive Consent Response Form (Spanish)	IC Document
M3. Student Assent Form.docx M3. Student Assent Form	IC Document
M4. Student Assent Form (Spanish).docx M4. Student Assent Form (Spanish)	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

SNMCS Individuals

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-N1. Child's Food Diary, Day 1 and Day 2	N1. Child's Food Diary, Day 1 and Day 2.docx	No	Paper Only
Other-N2. Child's Food Diary, Day 1 and Day 2 (Spanish)	N2. Child's Food Diary, Day 1 and Day 2 (Spanish).docx	No	Paper Only
Other-N3. Child-Youth Interview (In-Person Interview)	N3. Child-Youth Interview (In-Person Interview).docx	No	Paper Only
Other-N4. Child-Youth Interview (In-Person Interview) (Spanish)	N4. Child-Youth Interview (In-Person Interview) (Spanish).docx	No	Paper Only
Other-N5. Parent Interview (In-Person or Telephone Interview) 2014.04.02	N5. Parent Interview (In-Person or Telephone Interview) 2014.04.02.docx	No	Paper Only
Other-N6 Parent Interview (In-Person or Telephone Interview) (Spanish)	N6 Parent Interview (In-Person or Telephone Interview) (Spanish) (2).docx	No	Paper Only
Other-N7. Automated Multiple Pass Method (AMPM)	N7. Automated Multiple Pass Method (AMPM).docx	No	Paper Only
Other-O. Student Height and Weight Measurement Form	O. Student Height and Weight Measurement Form.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 FNS Studies and Reports

FR Citation: 56 FR 19078

Number of Respondents: 22,984

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 20 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	22,984	22,984
Annual IC Time Burden (Hours)	5,956	5,956
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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