Information Collection

Digital Nutrition Education Materials for Middle School Teachers (SLT) - IC 1 of 2

IC 225828 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⚠️ Notice: This information collection may be referencing outdated material.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 A_Consent Package for Teachers_Final.docx	Other-Attachment A Consent Package f
Attachment I_Teacher Focus Group Guideline_FInal.docx	Other-Attachment I Teacher Focus Gro
Attachment J_Teacher Interview Guideline_Grade 6 Final.docx	Other-Attachment J Teacher Interview
Attachment K_Teacher Journal Grade 6 Final.docx	Other-Attachment K Teacher Journal:
Attachment L_Teacher Interview Guideline_Grade 7 Final.docx	Other-Attachment L Teacher Interview
Attachment M_Teacher Journal Grade 7 Final.docx	Other-Attachment M Teacher Journal:
Attachment N_Teacher Interview Guideline_Grade 8 Final.docx	Other-Attachment N Teacher Interview
Attachment O_Teacher Journal Grade 8 Final.docx	Other-Attachment O Teacher Journal:
Attachment P_Teacher and Principal Communication Documents_Final.docx	Other-Attachment P Teacher and Princ
Attachment Q_Principal Letter of Agreement_Final.docx	Other-Attachment Q Principal Letter
Attachment B_Consent Package for Parent Final.docx	Other-Attachment B Consent Package f
Attachment C_Student Focus Group Package_Grade 6_Final.docx	Other-Attachment C Student Focus Gro
Attachment D_Student Survey Grade 6 Final.docx	Other-Attachment D Student Survey: G
Attachment E_Student Focus Group Package_Grade 7 Final.docx	Other-Attachment E Student Focus Gro
Attachment F_Student Survey Grade 7 Final.docx	Other-Attachment F Student Survey: G
Attachment G_Student Focus Group Package_Grade 8 Final.docx	Other-Attachment G Student Focus Gro
Attachment H_Student Survey Grade 8 Final.docx	Other-Attachment H Student Survey: G
Attachment R-1_Grade 6 Lesson Plan Final.pdf Attachment R-1 Grade 6 Lesson Plan	IC Document
Attachment R-2_Grade 6 Informational Text Articles-Final.pdf Attachment R-2 Grade 6 Informational Text Articles	IC Document
Attachment R-3_Grade 6 Informational Text Teacher Guide + Student Assessment-Final.pdf Attachment R-3 Grade 6 Informational Text Teacher Guide & Student Assessment	IC Document
Attachment R-4_Grade 6 Video Storyboard-Final.pdf Attachment R-4 Grade 6 Video Storyboard	IC Document
Attachment R-5_Grade 6 Interactive Wireframe-Final.pdf Attachment R-5 Grade 6 Interactive Wireframe	IC Document
Attachment S-1_Grade 7 Lesson Plan-Final.pdf Attachment S-1 Grade 7 Lesson Plan	IC Document
Attachment S-2_Grade 7 Informational Text Articles-Final.pdf Attachment S-2 Grade 7 Informational Text Articles	IC Document
Attachment S-3_Grade 7 Informational Text Teacher Guide + Student Assessment-Final.pdf Attachment S-3 Grade 7 Informational Text Teacher Guide & Student Assessment	IC Document
Attachment S-4_Grade 7 Video Storyboard-Final.pdf Attachment S-4 Grade 7 Video Storyboard	IC Document
Attachment S-5_Grade 7 Interactive Wireframe-Final.pdf Attachment S-5 Grade 7 Interactive Wireframe	IC Document
Attachment T-1_Grade 8 Lesson Plan-Final.pdf Attachment T-1 Grade 8 Lesson Plan	IC Document
Attachment T-2_Grade 8 Informational Text Articles-Final.pdf Attachment T-2 Grade 8 Informational Text Articles	IC Document
Attachment T-3_Grade 8 Informational Text Article Teacher Guide + Student Assessment-Final.pdf Attachment T-3 Grade 8 Informational Text Teacher Guide & Student Assessment	IC Document
Attachment T-4_Grade 8 Video Storyboard-Final.pdf Attachment T-4 Grade 8 Video Storyboard	IC Document
Attachment T-5_Grade 8 Interactive Wireframe - Final.pdf Attachment T-5 Grade 8 Interactive Wireframe	IC Document
20170223 Middle School Digital Nutrition Pilot_OMB Memo_FInal.pdf 20170223 Middle School Digital Nutrition Pilot_OMB Memo_FInal	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Digital Nutrition Education Materials for Middle School Teachers (SLT) - IC 1 of 2

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Electronic Capability
Other-Attachment A Consent Package for Teachers: Teacher Consent Cover Letter, Teacher Informed Consent Form, Questionnaire for Participation in Pilot	Attachment A_Consent Package for Teachers_Final.docx	No	Paper Only
Other-Attachment I Teacher Focus Group Guideline	Attachment I_Teacher Focus Group Guideline_FInal.docx	No	Paper Only
Other-Attachment J Teacher Interview Guideline: Grade 6	Attachment J_Teacher Interview Guideline_Grade 6 Final.docx	No	Paper Only
Other-Attachment K Teacher Journal: Grade 6	Attachment K_Teacher Journal Grade 6 Final.docx	No	Paper Only
Other-Attachment L Teacher Interview Guideline: Grade 7	Attachment L_Teacher Interview Guideline_Grade 7 Final.docx	No	Paper Only
Other-Attachment M Teacher Journal: Grade 7	Attachment M_Teacher Journal Grade 7 Final.docx	No	Paper Only
Other-Attachment N Teacher Interview Guideline: Grade 8	Attachment N_Teacher Interview Guideline_Grade 8 Final.docx	No	Paper Only
Other-Attachment O Teacher Journal: Grade 8	Attachment O_Teacher Journal Grade 8 Final.docx	No	Paper Only
Other-Attachment P Teacher and Principal Communication Documents: Initial Contact Email, Follow Up to Initial Contact Email, and Information about Pilot Opportunity	Attachment P_Teacher and Principal Communication Documents_Final.docx	No	Paper Only
Other-Attachment Q Principal Letter of Agreement	Attachment Q_Principal Letter of Agreement_Final.docx	No	Paper Only
Other-Attachment B Consent Package for Parent/Caregivers: Parent/Caregiver Consent Cover Letter, Parent/Caregiver Passive Consent Information	Attachment B_Consent Package for Parent Final.docx	No	Paper Only
Other-Attachment C Student Focus Group Package for Grade 6: Student Focus Group Guideline, Student Focus Group Questionnaire	Attachment C_Student Focus Group Package_Grade 6_Final.docx	No	Paper Only
Other-Attachment D Student Survey: Grade 6	Attachment D_Student Survey Grade 6 Final.docx	No	Paper Only
Other-Attachment E Student Focus Group Package for Grade 7: Student Focus Group Guideline, Student Focus Group Questionnaire	Attachment E_Student Focus Group Package_Grade 7 Final.docx	No	Paper Only
Other-Attachment F Student Survey: Grade 7	Attachment F_Student Survey Grade 7 Final.docx	No	Paper Only
Other-Attachment G Student Focus Group Package for Grade 8: Student Focus Group Guideline, Student Focus Group Questionnaire	Attachment G_Student Focus Group Package_Grade 8 Final.docx	No	Paper Only
Other-Attachment H Student Survey: Grade 8	Attachment H_Student Survey Grade 8 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: 272

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	662	662
Annual IC Time Burden (Hours)	375	375
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment R-1 Grade 6 Lesson Plan	Attachment R-1_Grade 6 Lesson Plan Final.pdf	02/28/2017
Attachment R-2 Grade 6 Informational Text Articles	Attachment R-2_Grade 6 Informational Text Articles-Final.pdf	02/28/2017
Attachment R-3 Grade 6 Informational Text Teacher Guide & Student Assessment	Attachment R-3_Grade 6 Informational Text Teacher Guide + Student Assessment-Final.pdf	02/28/2017
Attachment R-4 Grade 6 Video Storyboard	Attachment R-4_Grade 6 Video Storyboard-Final.pdf	02/28/2017
Attachment R-5 Grade 6 Interactive Wireframe	Attachment R-5_Grade 6 Interactive Wireframe-Final.pdf	02/28/2017
Attachment S-1 Grade 7 Lesson Plan	Attachment S-1_Grade 7 Lesson Plan-Final.pdf	02/28/2017
Attachment S-2 Grade 7 Informational Text Articles	Attachment S-2_Grade 7 Informational Text Articles-Final.pdf	02/28/2017
Attachment S-3 Grade 7 Informational Text Teacher Guide & Student Assessment	Attachment S-3_Grade 7 Informational Text Teacher Guide + Student Assessment-Final.pdf	02/28/2017
Attachment S-4 Grade 7 Video Storyboard	Attachment S-4_Grade 7 Video Storyboard-Final.pdf	02/28/2017
Attachment S-5 Grade 7 Interactive Wireframe	Attachment S-5_Grade 7 Interactive Wireframe-Final.pdf	02/28/2017
Attachment T-1 Grade 8 Lesson Plan	Attachment T-1_Grade 8 Lesson Plan-Final.pdf	02/28/2017
Attachment T-2 Grade 8 Informational Text Articles	Attachment T-2_Grade 8 Informational Text Articles-Final.pdf	02/28/2017
Attachment T-3 Grade 8 Informational Text Teacher Guide & Student Assessment	Attachment T-3_Grade 8 Informational Text Article Teacher Guide + Student Assessment-Final.pdf	02/28/2017
Attachment T-4 Grade 8 Video Storyboard	Attachment T-4_Grade 8 Video Storyboard-Final.pdf	02/28/2017
Attachment T-5 Grade 8 Interactive Wireframe	Attachment T-5_Grade 8 Interactive Wireframe - Final.pdf	02/28/2017
20170223 Middle School Digital Nutrition Pilot_OMB Memo_FInal	20170223 Middle School Digital Nutrition Pilot_OMB Memo_FInal.pdf	02/28/2017

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