| Evaluation of the Canned, Frozen, or Dried Fruits and Vegetables Pilot Project in the FFVP |
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| Appendix C.3c. DAILY MEAL COUNTS FORM |
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OMB Control No: 0584-XXXX |
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Expiration date: XX/XX/XXXX |
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| FRUITS AND VEGETABLES - DAILY MEAL AND SNACKS COUNT FORM |
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| 1. |
Your Name: |
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| 2. |
Name of School: |
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| 3. |
Target Week Dates: |
From ____/____/20___ To ____/____/20___ |
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| 4. |
Please record the total number of students enrolled in your school. |
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| 5. |
For each day of the target week, please record the total number of USDA reimbursable meals and snacks (breakfast, lunch, FFVP snacks) served in your school. Do not include meals for which you do not claim reimbursement, for example, second lunches sold to student on an à la carte basis. |
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Total Number of Reimbursable Breakfast Served |
Total Number of Reimbursable Lunch Served |
Total Number of Reimbursable FFVP Snacks Served |
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Monday |
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Tuesday |
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Wednesday |
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Thursday |
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Friday |
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| According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0584-XXXX. The time required to complete this information collection is estimated to average 5 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. |