Information Collection

State, Local, and Tribal Government - State Child Nutrition Agency, SFA, and Schools

IC 226899 under ICR 201705-0584-004 · OMB 0584-0530.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0530 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
B01 SFA Request for E-Records (Non-CEP schools for Household Sampling).docx	Other-Appendix B1. SFA Request for E
B02 SFA Reminder for E-Records (Non-CEP Schools for Household Sampling).docx	Other-Appendix B2. SFA Reminder for
B03 SFA Request for E-Records (CEP Schools for ISP Data Abstraction).docx	Other-Appendix B3. SFA Request for E
B04 SFA Reminder for E-Records (CEP Schools for ISP Data Abstraction).docx	Other-Appendix B4. SFA Reminder for
B05 SFA Pre-Visit Interview.docx	Other-Appendix B5. SFA Pre-Visit Int
B07 Application Data Abstraction Form.docx	Other-Appendix B7. Application Data
B08 Round 2 & 3 Application Data Abstraction Scheduling Email.docx	Other-Appendix B8. Round 2 & 3 Appli
B09 SFA Reimbursement Claim Verification Form - Sampled Schools.docx	Other-Appendix B9. SFA Reimbursement
B10 SFA Reimbursement Consolidation and Claim Verification Form - All Schools.docx	Other-Appendix B10. SFA Reimbursemen
B11 SFA Director Survey (Web Based).docx	Other-Appendix B11. SFA Director Sur
B12 SFA Director Interview (By Phone).docx	Other-Appendix B12. SFA Director Int
B13 SFA Meal Participation Data Request.docx	Other-Appendix B13. SFA Meal Partici
B14 State Meal Claim Data Request.docx	Other-Appendix B14. State Meal Claim
C01 School Pre-Visit Interview.docx	Other-Appendix C1. School Pre-Visit
C03 Meal Transaction Observation Form.docx	Other-Appendix C3. Meal Transaction
C05 Cafeteria Manager Interview.docx	Other-Appendix C5. Cafeteria Manager
C06 School Meal Count Verification Form.docx	Other-Appendix C6. School Meal Count
O02 Template E-Letter from FNS Regional Liaison to State Child Nutrition Director.docx	Other-Appendix O2. Template E-Letter
O03 State Follow Up Contact Guide.docx	Other-Appendix O3. State Follow Up C
O04 SFA Study Notification and School Data Verification E-Letter.pdf	Other-Appendix O4. SFA Study Notific
O05 SFA Follow Up Contact Guide (Study Notification and School Data Verification).docx	Other-Appendix O5. SFA Follow Up Con
O08 SFA School Sample Notification E-Letter.docx	Other-Appendix O8. SFA School Sample
B06 SFA Data Collection Visit Reminder Email.docx Appendix B6. SFA Data Collection Visit Reminder Email	IC Document
C04 Example of Meal Transaction Sampling 6.20.17.docx Appendix C4. Example of Meal Transaction Sampling	IC Document
C02 School Data Collection Visit Reminder Email.docx Appendix C2. School Data Collection Visit Reminder Email	IC Document
O06 SFA Automated Email - Receipt of Verification of School Data.docx Appendix O6. SFA Automated Email - Receipt of Verification of School Data	IC Document
O07 SFA Confirmation and Next Steps Email.docx Appendix O7. SFA Confirmation and Next Steps Email	IC Document
O09 School Study Notification E-Letter.docx Appendix O9. School Study Notification E-Letter	IC Document
O10 APEC III Fact Sheet (For SFAs and Schools).docx Appendix O10. APEC III Fact Sheet (for SFAs and Schools)	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

State, Local, and Tribal Government - State Child Nutrition Agency, SFA, and Schools

Agency IC Tracking Number:

Is this a Common Form? No

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-Appendix B1. SFA Request for E-Records (Non-CEP Schools for Household Sampling)	B01 SFA Request for E-Records (Non-CEP schools for Household Sampling).docx	Yes	Yes	Fillable Fileable
Other-Appendix B2. SFA Reminder for E-Records (Non-CEP Schools for Household Sampling)	B02 SFA Reminder for E-Records (Non-CEP Schools for Household Sampling).docx	Yes	Yes	Fillable Fileable
Other-Appendix B3. SFA Request for E-Records (CEP Schools for ISP Data Abstraction)	B03 SFA Request for E-Records (CEP Schools for ISP Data Abstraction).docx	Yes	Yes	Fillable Fileable
Other-Appendix B4. SFA Reminder for E-Records (CEP Schools for ISP Data Abstraction)	B04 SFA Reminder for E-Records (CEP Schools for ISP Data Abstraction).docx	Yes	Yes	Fillable Fileable
Other-Appendix B5. SFA Pre-Visit Interview	B05 SFA Pre-Visit Interview.docx	Yes	Yes	Paper Only
Other-Appendix B7. Application Data Abstraction Form	B07 Application Data Abstraction Form.docx	Yes	Yes	Fillable Fileable
Other-Appendix B8. Round 2 & 3 Application Data Abstraction Scheduling Email	B08 Round 2 & 3 Application Data Abstraction Scheduling Email.docx	Yes	Yes	Fillable Fileable
Other-Appendix B9. SFA Reimbursement Claim Verification Form - Sampled Schools	B09 SFA Reimbursement Claim Verification Form - Sampled Schools.docx	Yes	Yes	Fillable Fileable
Other-Appendix B10. SFA Reimbursement Consolidation and Claim Verification Form - All Schools	B10 SFA Reimbursement Consolidation and Claim Verification Form - All Schools.docx	Yes	Yes	Fillable Fileable
Other-Appendix B11. SFA Director Survey (web based)	B11 SFA Director Survey (Web Based).docx	Yes	Yes	Fillable Fileable
Other-Appendix B12. SFA Director Interview (by phone)	B12 SFA Director Interview (By Phone).docx	No		Paper Only
Other-Appendix B13. SFA Meal Participation Data Request	B13 SFA Meal Participation Data Request.docx	Yes	Yes	Fillable Fileable
Other-Appendix B14. State Meal Claim Data Request	B14 State Meal Claim Data Request.docx	Yes	Yes	Fillable Fileable
Other-Appendix C1. School Pre-Visit Interview	C01 School Pre-Visit Interview.docx	Yes	No	Fillable Printable
Other-Appendix C3. Meal Transaction Observation Form	C03 Meal Transaction Observation Form.docx	No		Paper Only
Other-Appendix C5. Cafeteria Manager Interview	C05 Cafeteria Manager Interview.docx	No		Paper Only
Other-Appendix C6. School Meal Count Verification Form	C06 School Meal Count Verification Form.docx	No		Paper Only
Other-Appendix O8. SFA School Sample Notification E-Letter	O08 SFA School Sample Notification E-Letter.docx	Yes	Yes	Fillable Fileable
Other-Appendix O2. Template E-Letter from FNS Regional Liaison to State Child Nutrition Director	O02 Template E-Letter from FNS Regional Liaison to State Child Nutrition Director.docx	Yes	No	Fillable Printable
Other-Appendix O3. State Follow Up Contact Guide	O03 State Follow Up Contact Guide.docx	No		Paper Only
Other-Appendix O4. SFA Study Notification and School Data Verification E-Letter	O04 SFA Study Notification and School Data Verification E-Letter.pdf	Yes	Yes	Fillable Fileable
Other-Appendix O5. SFA Follow Up Contact Guide (Study Notification and School Data Verification)	O05 SFA Follow Up Contact Guide (Study Notification and School Data Verification).docx	Yes	No	Fillable Printable

Federal Enterprise Architecture Business Reference Module

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records

Title: FNS-8 USDA/FNS Studies and Reports

FR Citation: 56 FR 19078

Number of Respondents: 2,801

Number of Respondents for Small Entity: 19

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 21 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	10,084	10,084
Annual IC Time Burden (Hours)	4,521	4,521
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Appendix B6. SFA Data Collection Visit Reminder Email	B06 SFA Data Collection Visit Reminder Email.docx	05/17/2017
Appendix C4. Example of Meal Transaction Sampling	C04 Example of Meal Transaction Sampling 6.20.17.docx	06/20/2017
Appendix C2. School Data Collection Visit Reminder Email	C02 School Data Collection Visit Reminder Email.docx	05/17/2017
Appendix O6. SFA Automated Email - Receipt of Verification of School Data	O06 SFA Automated Email - Receipt of Verification of School Data.docx	05/18/2017
Appendix O7. SFA Confirmation and Next Steps Email	O07 SFA Confirmation and Next Steps Email.docx	05/18/2017
Appendix O9. School Study Notification E-Letter	O09 School Study Notification E-Letter.docx	05/18/2017
Appendix O10. APEC III Fact Sheet (for SFAs and Schools)	O10 APEC III Fact Sheet (For SFAs and Schools).docx	05/18/2017

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