State, Local and Tribal Agencies (Respondents)

OMB Control No: 0584-XXXX

Expiration Date: XX/XX/20XX

Appendix D5a. Site Operations Survey Web Screen Shot

SITE OPERATIONS SURVEY

Please answer the following questions about the following Summer Food Service Program (SFSP) or Seamless Summer Option (SSO) sites under your sponsorship. <SITE NAME 1> Will <SITE NAME> participate in the Summer Food Service Program or Seamless Summer Option in Summer 2018?   YES NO  PROGRAMMER: SKIP TO <SITE NAME 2> Don’t know at this time, decision will be made by ENTER DATE HERE  PROGRAMMER: SKIP TO <SITE NAME 2> What is the start and end date for offering the summer meal program at this site? START DATE: Click or tap to enter a date. END DATE: Click or tap to enter a date. Does this site operate: PROGRAMMER – ONLY ONE RESPONSE ALLOWED Every week from start date to end date Some weeks from start to end date

Public reporting burden for this collection of information is estimated to average 15 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. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: U.S. Department of Agriculture, Food and Nutrition Services, Office of Policy Support, 3101 Park Center Drive, Room 1014, Alexandria, VA 22302 ATTN: PRA (0584-xxxx*). Do not return the completed form to this address.