Information Collection

State Agencies (Schools)

IC 211307 under ICR 201404-0584-009 · OMB 0584-0595.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0595 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appendix A1 Online Survey Screen Shots for OMB.docx www.surveymonkey.com	Other-Appendix A1 Online Survey Scre
Appendix E1 State Survey Instrument.docx www.surveymonkey.com	Other-Appendix E1 State Survey Instr
Appendix E2 State MOU.doc Appendix E2 State MOU	IC Document
Appendix E3 State Survey E-mail Invite Text-Script.docx Appendix E3 State Survey E-mail Invite Text-Script	IC Document
Appendix E4 State Intro Letter.docx Appendix E4 State Intro Letter	IC Document
Appendix E5 State Survey Reminder Text-Script.docx Appendix E5 State Survey Reminder Text-Script	IC Document
Appendix E6 State Webinar.pptx Appendix E6 State Webinar	IC Document
Appendix F8 Sponsor Info First Request.docx Appendix F8 Sponsor Info First Request Letter to State Agencies	IC Document
Appendix F9 Sponsor Info Second Request.docx Appendix F9 Sponsor Info Second Request Letter to State Agencies	IC Document
Appendix L1 School District Letter.docx Appendix L1 School District Letter	IC Document
Appendix L2 School District Thank you.docx Appendix L2 School District Thank you	IC Document

IC Title:

State Agencies (Schools)

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	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Appendix A1 Online Survey Screen Shots			Appendix A1 Online Survey Screen Shots for OMB.docx	www.surveymonkey.com	Yes	Yes	Fillable Fileable Signable
Other-Appendix E1 State Survey Instrument			Appendix E1 State Survey Instrument.docx	www.surveymonkey.com	Yes	Yes	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 54

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 90 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	452	452
Annual IC Time Burden (Hours)	371	371
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Appendix E2 State MOU	Appendix E2 State MOU.doc	04/23/2014
Appendix E3 State Survey E-mail Invite Text-Script	Appendix E3 State Survey E-mail Invite Text-Script.docx	04/23/2014
Appendix E4 State Intro Letter	Appendix E4 State Intro Letter.docx	04/23/2014
Appendix E5 State Survey Reminder Text-Script	Appendix E5 State Survey Reminder Text-Script.docx	04/23/2014
Appendix E6 State Webinar	Appendix E6 State Webinar.pptx	04/23/2014
Appendix F8 Sponsor Info First Request Letter to State Agencies	Appendix F8 Sponsor Info First Request.docx	04/23/2014
Appendix F9 Sponsor Info Second Request Letter to State Agencies	Appendix F9 Sponsor Info Second Request.docx	04/23/2014
Appendix L1 School District Letter	Appendix L1 School District Letter.docx	04/23/2014
Appendix L2 School District Thank you	Appendix L2 School District Thank you.docx	04/23/2014

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