FNS-791 Promising Practices Submission Form

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U.S. Department of Agriculture
Food and Nutrition Service
Promising Practices Submission Form

Form Approved OMB No.0584-0524
Expiration Date: XX/XX/XXXX

1. Contact Information
Please provide contact information for the person submitting the practice.
First Name, MI, Last Name
Position
Organization
Address
City, State, Zip
Telephone
E-Mail
Preferred Method of Contact: Phone
Email
Please identify a contact person who can provide additional information about the Promising
Practice. This contact information will be posted on the FNS public website at
http://www.fns.usda.gov/snap/outreach/default.htm or http://www.fns.usda.gov/fns/outreach.htm.
First Name, MI, Last Name
Position
Organization
Address
City, State, Zip
Telephone
E-Mail
Preferred Method of Contact: Phone
Email
2. What is the Promising Practice?
Short Descriptive Title:
Brief description (two sentences):

Long description:

Please include (attach/upload) additional text as necessary.
Attach / upload

For which program(s) is this promising practice?
Promising Practice start and end date?
Which clients did this promising practice target?
Please provide a list of stakeholders involved in developing, implementing and evaluating the Promising
Practice.
• Were program participants consulted in the development of the Promising Practice?
• Do partners in the program have a memorandum of understanding (MOU) or any other type
of written agreement?
Form FNS-791 (07-09) Previous Editions are Obsolete

SBU

Electronic Form Version Designed in Adobe 8.1 version

What is the geographic scope of your Promising Practice? (Please check all that apply and list the
appropriate location names)
City/Municipal
County
State
Regional
National

Suburban
Internal/Office
Unknown
Other
(please describe):

Tribal
Urban
Rural

To help users successfully search for this Promising Practice, list any keywords that describe the
Promising Practice:
3. Objectives and Results
In 2-3 sentences, please describe the issue or problem your Promising Practice addresses.

How does the Promising Practice overcome this issue or problem?
A Promising Practice must meet one or more of the criteria listed below. Please indicate the criterion(a) under
which the practice qualifies and describe how it qualifies in the space provided. (Check all that apply).
1. Superior results or performance
2. New or innovative use of resource(s)
3. New or innovative partnership.
4. High level of customer satisfaction.
What do program participants have to say about your Promising Practice?

Please include (attach/upload) any available empirical evidence attesting to the effectiveness of your practice.
Attach / upload

If your project involved the Supplemental Food Nutrition Assistance Program (SNAP), are you receiving
reimbursements through your State's outreach plan?

Form FNS-791 (07-09) Previous Editions are Obsolete

SBU

Electronic Form Version Designed in Adobe 8.1 version

5. Lessons Learned
Briefly identify the key resources used to implement the Promising Practice.
Were there any unanticipated costs associated with the practice? Please describe.
Please identify the key factors in making the Promising Practice successful.
What were some of the challenges faced in designing and implementing the Promising Practice and how
were they overcome?
Would you do anything differently? Please describe what you would change and why.
Please identify any additional online resources (e.g. URLs, websites, reports or studies) that were used to
design or implement your Promising Practice.
Did the State or local agency make policy changes in order to implement this Promising Practice? If so,
please describe them.
What advice would you give to other groups interested in replicating your practice?

6. Additional Information (OPTIONAL)
Please provide any additional information you would like to share concerning your Promising Practice.

Please feel free to attach any addition relevant information such as photographs, documents, training
manuals, outreach materials, etc. that you developed.
Attach

[This form can be completed online or can be submitted by email to the Outreach Coalition at
[email protected], or sent to the Outreach Coalition Promising Practices Committee,
Food and Nutrition Service, 3101 Park Center Drive, Room 1441, Alexandria, Virginia 22302.]
Thank you for your contribution!
OMB BURDEN STATEMENT: 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
0584-0524. The time required to complete this information collection is estimated to average 45 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. If you
have any comments concerning the accuracy of time estimates or suggestions for improving this form, please contact: U.S. Department of Agriculture, Food
and Nutrition Service, Office of Research and Analysis, Room 1012, Alexandria, VA 22302.

Form FNS-791 (07-09) Previous Editions are Obsolete

SBU

Electronic Form Version Designed in Adobe 8.1 version