Information Collection

State Agencies (Schools)

IC 211307 under ICR 201411-0584-002 · OMB 0584-0595.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appendix A1 Online Survey Screen Shots for OMB.docx	Other-Appendix A1 Online Survey Scre
Appendix E1 State Survey Instrument.docx	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 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
Appendix E4 State Intro Letter 2014 10 31.docx Appendix E4 State Intro Letter 2014 10 31	IC Document
Appendix E7 State Webinar Save the Date 2014 11 05 v2.docx Appendix E7 State Webinar Save the Date 2014 11 05 v2	IC Document
Appendix B1 State Informational Brochure (formerly Appendix B1 SFSP Informational Brochure).pdf Appendix B1 State Informational Brochure (formerly Appendix B1 SFSP Informational Brochure)	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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				www.surveymonkey.com	Yes	Yes	Fillable Fileable Signable
Other-Appendix E1 State Survey Instrument				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	Previously Approved
Annual Number of Responses for this IC	560	108	452
Annual IC Time Burden (Hours)	560	189	371
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Appendix E2 State MOU		04/23/2014
Appendix E3 State Survey E-mail Invite Text-Script		04/23/2014
Appendix E5 State Survey Reminder Text-Script		04/23/2014
Appendix E6 State Webinar		04/23/2014
Appendix F8 Sponsor Info First Request Letter to State Agencies		04/23/2014
Appendix F9 Sponsor Info Second Request Letter to State Agencies		04/23/2014
Appendix L1 School District Letter		04/23/2014
Appendix L2 School District Thank you		04/23/2014
Appendix E4 State Intro Letter 2014 10 31		11/18/2014
Appendix E7 State Webinar Save the Date 2014 11 05 v2		11/18/2014
Appendix B1 State Informational Brochure (formerly Appendix B1 SFSP Informational Brochure)		11/24/2014

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

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