Appendix 21.a Household Survey Brochure - English

Supporting Statement for OMB Clearance for the Study of Non-Response to the
School Meals Application Verification Process
Appendix 21a
Household Survey Brochure (English)

Why should I take part?
Your answers will help make sure the
federal dollars that support free and
reduced-price school meals are reaching
the children who need them. Your
opinions about the application process
for signing up for the meal program at
your child’s school are vital to helping
improve these programs. To thank you
for taking part in the interview, you will
receive a $25 VISA gift card.

Do I have to take part?

For more information,
about the
USDA/FNS School Meal
Application Study,
please contact:
Mathematica Policy Research
Toll Free Phone: XXX-XXX-XXXX
[email protected]
Visit our website:
www.mathematica-mpr.com

No, your participation is voluntary
and you can refuse to answer any
question during the interview. But, your
participation is vital to the FNS’ efforts to
make these programs better.

Why are you asking about
income?
Income information will help us
learn more about the families taking
part in the program. Your accuracy
in responding to these questions is
important. The answers you provide
will be private and will only be used for
planning purposes. Your answers will not
affect your child’s eligibility to receive
school meal program benefits.

USDA is an equal opportunity
provider and employer
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 0584XXXX. The time required to complete this
information collection is estimated to average six
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.

School Meal
Application Study
Sponsored by the U.S. Department of Agriculture
Food and Nutrition Service

Conducted by
Mathematica Policy Research

Who is conducting the study?
Mathematica Policy Research is conducting
this study for the U.S. Department of
Agriculture (USDA) Food and Nutrition
Service (FNS). Mathematica Policy Research
has studied school meal programs for more
than 25 years.

What will I be asked?

Why is this study being done?

• Experience with the school meals
program application

The FNS is funding this study to learn
about households taking part in the
school meals program. FNS hopes
to better understand households’
experiences with applying for the school
meals program.

• Satisfaction with the school meals
program

How long will the interview take?
We will conduct a 45-minute in-person
interview. We will schedule the interview
at a time that is good for you and the study
team. And before the interview, it may
also take about 2 hours for you to locate
documentation we will ask you to provide.

The person who interviews you may
ask about your family’s:

Why did you choose
my household?

• Participation in the school meals
program

Your household was randomly selected
from a list of households that applied for
the school meals program. The survey is
designed to represent households in your
school district. The answers you provide
will help create an accurate picture of the
households that take part in the school meals
program. To thank you for taking part in the
study, you will receive a $25 VISA gift card.

• Household characteristics
• Eligibility for school meals, including
household size and income sources
• We will ask for documentation of income
amounts from October 2017. The types of
documentation we may need to review
include:
• Paycheck stubs
• Notice from Social Security about your
retirement benefits
• Notice of eligibility for unemployment
benefits from your State
• Welfare benefits letter from your local
Family Resources Office
• Court decree or agreement indicating
the amount of alimony or child support
• If you use military housing, we will
need a letter showing that your
housing is part of the Military Housing
Privatization

Will my answers be kept private?
All information gathered for the study
is private. The Mathematica interviewer
signed a confidentiality statement that
keeps him or her from sharing your personal
information with anyone other than
authorized research staff. No information
on individual children or families will
be reported. The study results will be
summarized in such a way that no family can
ever be identified.

If my child does not eat school
meals, should I still take part?
Yes. Even if your child has never eaten a
school breakfast or lunch, we need your
participation to better understand how the
school meal programs are working in your
district. We also want to understand why
families do not take part in the programs.