Information Collection

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

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

Documents and Forms

Documents and forms in this information collection
Document NameDocument 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)

layout table

Information Collection Instruments:
table that charts list of instruments
Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Appendix B1. SFA Request for E-Records (Non-CEP Schools for Household Sampling) Yes Yes Fillable Fileable
Other-Appendix B2. SFA Reminder for E-Records (Non-CEP Schools for Household Sampling) Yes Yes Fillable Fileable
Other-Appendix B3. SFA Request for E-Records (CEP Schools for ISP Data Abstraction) Yes Yes Fillable Fileable
Other-Appendix B4. SFA Reminder for E-Records (CEP Schools for ISP Data Abstraction) Yes Yes Fillable Fileable
Other-Appendix B5. SFA Pre-Visit Interview Yes Yes Paper Only
Other-Appendix B7. Application Data Abstraction Form Yes Yes Fillable Fileable
Other-Appendix B8. Round 2 & 3 Application Data Abstraction Scheduling Email Yes Yes Fillable Fileable
Other-Appendix B9. SFA Reimbursement Claim Verification Form - Sampled Schools Yes Yes Fillable Fileable
Other-Appendix B10. SFA Reimbursement Consolidation and Claim Verification Form - All Schools Yes Yes Fillable Fileable
Other-Appendix B11. SFA Director Survey (web based) Yes Yes Fillable Fileable
Other-Appendix B12. SFA Director Interview (by phone) No   Paper Only
Other-Appendix B13. SFA Meal Participation Data Request Yes Yes Fillable Fileable
Other-Appendix B14. State Meal Claim Data Request Yes Yes Fillable Fileable
Other-Appendix C1. School Pre-Visit Interview Yes No Fillable Printable
Other-Appendix C3. Meal Transaction Observation Form No   Paper Only
Other-Appendix C5. Cafeteria Manager Interview No   Paper Only
Other-Appendix C6. School Meal Count Verification Form No   Paper Only
Other-Appendix O2. Template E-Letter from FNS Regional Liaison to State Child Nutrition Director Yes No Fillable Printable
Other-Appendix O3. State Follow Up Contact Guide No   Paper Only
Other-Appendix O4. SFA Study Notification and School Data Verification E-Letter Yes Yes Fillable Fileable
Other-Appendix O5. SFA Follow Up Contact Guide (Study Notification and School Data Verification) Yes No Fillable Printable
Other-Appendix O8. SFA School Sample Notification E-Letter Yes Yes Fillable Fileable

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 10,084 0 10,084 0 0 0
Annual IC Time Burden (Hours) 4,521 0 4,521 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Documents for IC
table that charts IC Documents
Title Document Date Uploaded
Appendix B6. SFA Data Collection Visit Reminder Email 05/17/2017
Appendix C4. Example of Meal Transaction Sampling 06/20/2017
Appendix C2. School Data Collection Visit Reminder Email 05/17/2017
Appendix O6. SFA Automated Email - Receipt of Verification of School Data 05/18/2017
Appendix O7. SFA Confirmation and Next Steps Email 05/18/2017
Appendix O9. School Study Notification E-Letter 05/18/2017
Appendix O10. APEC III Fact Sheet (for SFAs and Schools) 05/18/2017
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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