Information Collection

Team Nutrition Cooks - State, Local, and Tribal Government

IC 225228 under ICR 201606-0584-008 · OMB 0584-0524.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0524 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment B - USDA Team Nutrition Cooks_Program Operator Informed Consent Final.docx	Other-Attachment B Program Operator
Attachment E - USDA Team Nutrition Cooks_Lesson Feedback Worksheet for Program Operators Final.docx	Other-Attachment E Lesson Feedback W
Attachment F - USDA Team Nutrition Cooks_Discussion Guide for IDI with Program Operators Final.docx	Other-Attachment F Discussion Guide
Attachment H - USDA Team Nutrition Cooks_Demographics for Parents and Program Operators Final.docx	Other-Attachment H Demographics for
Attachment K - USDA Team Nutrition Cooks_Lesson Attendance Sheet Final.docx	Other-Attachment K Lesson Attendance
Attachment L - USDA Team Nutrition Cooks_Confirmation Letter for Administrator Final.docx	Other-Attachment L Confirmation Lett
Attachment P - USDA Team Nutrition Cooks_Draft agenda for kickoff meeting with program operators Final.docx	Other-Attachment P Draft Agenda for
Attachment A-USDA Team Nutrition Cooks_Parent Caregiver Informed Consent for Child Participation Final.docx	Other-Attachment A Parent/Caregiver
Attachment C - USDA Team Nutrition Cooks_Questionnaire for Student Pre-post Survey Final.docx	Other-Attachment C Questionnaire for
Attachment D - USDA Team Nutrition Cooks_Lesson Feedback Worksheet for Students Final.docx	Other-Attachment D Lesson Feedback W
Attachment G - USDA Team Nutrition Cooks_Discussion Guide for Focus Groups with Parents Final.docx	Other-Attachment G Discussion Guide
Attachment N - USDA Team Nutrition Cooks_Parent Caregiver Informed Consent for Focus Group Final.docx	Other-Attachment N Parent/Caregiver
Attachment M AppleSauce_405psf2398_178_EN20_sub.mp4 Attachment M - Stimuli for IDIS - Team Nutrition Cooks! Videos	IC Document
Attachment M Pancakes_405psf2398_178_EN20_sub.mp4 Attachment M Stimuli for IDIS - Team Nutrition Cooks Videos (Pancakes)	IC Document
Attachment M Quinoa_405psf2398_178_EN20_sub.mp4 Attachment M Stimuli for IDIS - Team Nutrition Cooks! Videos (Quinoa)	IC Document
Attachment M Salad_405psf2398_178_EN20_sub.mp4 Attachment M Stimuli for IDSs - Team Nutrition Cooks! Videos (Salad)	IC Document
Attachment M ScambledEggs_405psf2398_178_EN20_sub.mp4 Attachment M Stimuli for IDIs - Team Nutrition Cooks! Videos (Scrambled Eggs)	IC Document
Attachment M Stimuli for IDIs.pdf Attachment M Stimuli for IDIs - Team Nutrition Cooks! Activity Guides	IC Document
Attachment I - USDA Team Nutrition Cooks_Sample Informational Email to Parents Final.docx Attachment I Sample Informational Email to Parents/Caregivers	IC Document
Attachment J - USDA Team Nutrition Cooks_Sample Recruitment Email for Parent Focus Group Final.docx Attachment J Sample Recruitment Email for Parent/Caregiver Focus Group	IC Document
Attachment O Stimuli for Focus Groups.pdf Attachment O Stimuli for Focus Groups - Team Nutrition Cooks! Family Handouts	IC Document
USDA Team Nutrition Cooks_OMB Memo_Final 02217.pdf USDA Team Nutrition Cooks OMB Memo Final 02217	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Team Nutrition Cooks - State, Local, and Tribal Government

Agency IC Tracking Number:

Team Nutrition Cooks

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Attachment B Program Operator Informed Consent	Attachment B - USDA Team Nutrition Cooks_Program Operator Informed Consent Final.docx	No		Paper Only
Other-Attachment E Lesson Feedback Worksheet for Program Operators	Attachment E - USDA Team Nutrition Cooks_Lesson Feedback Worksheet for Program Operators Final.docx	No		Paper Only
Other-Attachment F Discussion Guide for In-Depth Interviews with Program Operators	Attachment F - USDA Team Nutrition Cooks_Discussion Guide for IDI with Program Operators Final.docx	No		Paper Only
Other-Attachment H Demographics for Parents and Program Operators	Attachment H - USDA Team Nutrition Cooks_Demographics for Parents and Program Operators Final.docx	No		Paper Only
Other-Attachment A Parent/Caregiver Informed Consent for Child Participation	Attachment A-USDA Team Nutrition Cooks_Parent Caregiver Informed Consent for Child Participation Final.docx	No		Paper Only
Other-Attachment C Questionnaire for Student Pre-/Post-Intervention Survey	Attachment C - USDA Team Nutrition Cooks_Questionnaire for Student Pre-post Survey Final.docx	Yes	Yes	Fillable Fileable
Other-Attachment D Lesson Feedback Worksheet for Students	Attachment D - USDA Team Nutrition Cooks_Lesson Feedback Worksheet for Students Final.docx	No		Paper Only
Other-Attachment G Discussion Guide for Focus Groups with Parents/Caregivers	Attachment G - USDA Team Nutrition Cooks_Discussion Guide for Focus Groups with Parents Final.docx	No		Paper Only
Other-Attachment N Parent/Caregiver Informed Consent for Focus Group	Attachment N - USDA Team Nutrition Cooks_Parent Caregiver Informed Consent for Focus Group Final.docx	No		Paper Only
Other-Attachment K Lesson Attendance Sheet for Program Operators	Attachment K - USDA Team Nutrition Cooks_Lesson Attendance Sheet Final.docx	No		Paper Only
Other-Attachment L Confirmation Letter for Administrator/Principal	Attachment L - USDA Team Nutrition Cooks_Confirmation Letter for Administrator Final.docx	No		Paper Only
Other-Attachment P Draft Agenda for Kickoff Meeting with Program Operators	Attachment P - USDA Team Nutrition Cooks_Draft agenda for kickoff meeting with program operators Final.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: 15

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	171	171
Annual IC Time Burden (Hours)	29	29
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment M - Stimuli for IDIS - Team Nutrition Cooks! Videos	Attachment M AppleSauce_405psf2398_178_EN20_sub.mp4	01/18/2017
Attachment M Stimuli for IDIS - Team Nutrition Cooks Videos (Pancakes)	Attachment M Pancakes_405psf2398_178_EN20_sub.mp4	01/18/2017
Attachment M Stimuli for IDIS - Team Nutrition Cooks! Videos (Quinoa)	Attachment M Quinoa_405psf2398_178_EN20_sub.mp4	01/18/2017
Attachment M Stimuli for IDSs - Team Nutrition Cooks! Videos (Salad)	Attachment M Salad_405psf2398_178_EN20_sub.mp4	01/18/2017
Attachment M Stimuli for IDIs - Team Nutrition Cooks! Videos (Scrambled Eggs)	Attachment M ScambledEggs_405psf2398_178_EN20_sub.mp4	01/18/2017
Attachment M Stimuli for IDIs - Team Nutrition Cooks! Activity Guides	Attachment M Stimuli for IDIs.pdf	01/18/2017
Attachment I Sample Informational Email to Parents/Caregivers	Attachment I - USDA Team Nutrition Cooks_Sample Informational Email to Parents Final.docx	01/20/2017
Attachment J Sample Recruitment Email for Parent/Caregiver Focus Group	Attachment J - USDA Team Nutrition Cooks_Sample Recruitment Email for Parent Focus Group Final.docx	01/20/2017
Attachment O Stimuli for Focus Groups - Team Nutrition Cooks! Family Handouts	Attachment O Stimuli for Focus Groups.pdf	01/20/2017
USDA Team Nutrition Cooks OMB Memo Final 02217	USDA Team Nutrition Cooks_OMB Memo_Final 02217.pdf	02/02/2017

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