Respondent - Business

Summer Meal Study (PC MAQ)

F9. Site Menu Follow-Up Report Revised CLEAN

Respondent - Business

OMB: 0584-0635

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OMB Control No: 0584-XXXX

Expiration Date: XX/XX/20XX



Appendix F9. Site Menu Follow-Up Report



Instructions

Your list of foods and beverages served and their recipes provided most of the information we need. In the tables below, we list items for which we need additional details organized by the type of meal component the item provides.


There are five meal components: Grains, Fruits, Vegetables, Meats/Meat Alternates/Cheese, and Milk. If the menu item was a combined food (like a sandwich) or a mixed dish (like pizza), the table lists the ingredient followed by the menu item containing the ingredient. For example, if the menu item was a peanut butter and jelly sandwich, we may have questions about the bread in the sandwich. The table will list “Bread (peanut butter & jelly sandwich)” in the section on Grains, and “Peanut butter (peanut butter & jelly sandwich)” in the section on Meats/Meat Alternates/Cheese (see Figure 1.)



Figure 1. Followup report questions for components of PB&J sandwich



The details needed vary for the type of food, and include:

  • Brand name and product name

  • Grains: The details needed vary by the Meal Pattern you use:

    • If using the SFSP meal pattern: Was the item whole grain, enriched, or (for cereals only) fortified?

    • If using the CACFP or NSLP meal pattern: Was the item whole grain-rich, enriched, or (for cereals only) fortified?

  • Fruits & Vegetables: Were they:

    • Peeled?

    • Whole, sliced, diced, shredded?

    • Raw, canned, cooked or dried?

      • For canned fruit, was it packed in heavy syrup, light syrup, extra light syrup, juice, or water?

      • For cooked fruit or vegetable, was it made from

        • Fresh

        • Frozen

        • Canned

        • Dried

      • For cooked fruit or vegetable, how was it prepared?

        • Baked/roasted

        • Microwaved

        • Broiled/grilled

        • Pan-fried/sautéed

        • Deep fried

        • Boiled

        • Steamed

        • Other (specify

  • Meat, meat alternative, cheese: Was the item regular, lean, reduced-fat or fat-free?

  • Milk: Was it

    • Plain or flavored?

    • Regular (whole), reduced-fat (2%), low-fat (1%), fat-free (skim)

  • Fruit or vegetable juice: Was it 100% juice?


The table on the following pages shows an example of the form. The type of information that will be pre-filled is shown in black. The responses that a sponsor provided are shown in blue. The table with your menu items and the details needed begins on page ___.


If you have any questions about this form, please contact the study team at XXX-XXX-XXXX or [email protected].


SAMPLE 1 – For sites using SFSP Meal Pattern

Sponsor Name: ____Sponsor ABC_________________ Meal pattern: ____SFSP____

Site: ______Site XYZ_______


Menu week: ___2___ Week start date: ___6/26/2018

GRAINS



DAY

MEAL

MENU ITEM

ADDITIONAL DETAILS

M

B

Mini pancakes

What kind was it?

Blueberry whole wheat

What was the brand name?

Aunt Jemima

Was it: Whole grain

Enriched

W

L

Bread (Chicken sandwich)

What kind was it?

White Sandwich

What was the brand name?

Nickel’s

Was it: Whole grain

Enriched

FRUITS/VEGETABLES


DAY

MEAL

MENU ITEM

ADDITIONAL DETAILS

M

L

Vegetable

What kind was it?

Baby carrots

Was it peeled?

Yes No

What was the form?

Whole Sliced Diced Shredded

How was it prepared?

Raw Cooked

If cooked, was it from

Fresh Frozen Canned Dried

What was the brand name?


F

L

Fruit

What kind was it?

Applesauce

What was the form?

Whole Sliced Diced Shredded

How was it prepared?

Fresh Frozen Canned Dried

If canned, was it

Packed in water or unsweetened

Packed in juice

Packed in syrup or sweetened

Was the syrup:

Heavy Light Extra light

What was the brand name?

Motts

MEAT/MEAT ALTERNATE/CHEESE


DAY

MEAL

MENU ITEM

ADDITIONAL DETAILS

M

B

Cheese stix

What kind was it?

Mozzarella cheese stick

What was the brand name?

Poly-O

Was it:

Regular Reduced fat Fat free


D

Peanut butter (PBJ Uncrustable)

Was it:

Regular Reduced fat

MILK


DAY

MEAL

MENU ITEM

ADDITIONAL DETAILS

M

B

None

Was milk served?

Yes No

Plain or flavored?

Plain Flavored

Was it:

Regular (Whole or vitamin D)

Reduced-fat (2%)

Low-fat (1%)

Fat-free (skim)

ADDITIONAL INGREDIENTS: Did the following foods include ingredients not mentioned in the name of the food?

DAY

MEAL

MENU ITEM

ADDITIONAL DETAILS

M

L

Pizza

What kind was it?

Cheese pizza

What was the brand name?

No brand name

Did it include meat?

Yes No

If yes, what kind of meat was it?


Was the meat:

Regular Lean




Did it include any vegetables?

Yes No

If yes, what kind of vegetable was it?


Was the vegetable peeled?

Yes No

What was the form of the vegetable?

Whole Sliced

Diced Shredded

How was the vegetable prepared?

Raw Cooked

If cooked, was it from

Fresh Frozen

Canned Dried

T

B

Ham/Egg Scrambler

Did it include any vegetables?

Yes No

If yes, what kind of vegetable was it?


Was the vegetable peeled?

Yes No

What was the form of the vegetable?

Whole Sliced

Diced Shredded

How was the vegetable prepared?

Raw Cooked

If cooked, was it from

Fresh Frozen

Canned Dried




SAMPLE 2 – For sites using CACFP or NSLP Meal Pattern

Sponsor Name: ____Sponsor ABC_________________ Meal pattern: ____CACFP____


Site: ______Site XYZ_______


Menu week: ___2___ Week start date: ___6/26/2018

GRAINS



DAY

MEAL

MENU ITEM

ADDITIONAL DETAILS

M

B

Mini pancakes

What kind was it?

Blueberry whole wheat

What was the brand name?

Aunt Jemima

Was it: Whole grain-rich

Enriched

W

L

Bread (Chicken sandwich)

What kind was it?

White Sandwich

What was the brand name?

Nickel’s

Was it: Whole grain-rich

Enriched

FRUITS/VEGETABLES


DAY

MEAL

MENU ITEM

ADDITIONAL DETAILS

M

L

Vegetable

What kind was it?

Baby carrots

Was it peeled?

Yes No

What was the form?

Whole Sliced Diced Shredded

How was it prepared?

Raw Cooked

If cooked, was it from

Fresh Frozen Canned Dried

What was the brand name?


F

L

Fruit

What kind was it?

Applesauce

What was the form?

Whole Sliced Diced Shredded

How was it prepared?

Fresh Frozen Canned Dried

If canned, was it

Packed in water or unsweetened

Packed in juice

Packed in syrup or sweetened

Was the syrup:

Heavy Light Extra light

What was the brand name?

Motts

MEAT/MEAT ALTERNATE/CHEESE


DAY

MEAL

MENU ITEM

ADDITIONAL DETAILS

M

B

Cheese stix

What kind was it?

Mozzarella cheese stick

What was the brand name?

Poly-O

Was it:

Regular Reduced fat Fat free


D

Peanut butter (PBJ Uncrustable)

Was it:

Regular Reduced fat

MILK


DAY

MEAL

MENU ITEM

ADDITIONAL DETAILS

M

B

None

Was milk served?

Yes No

Plain or flavored?

Plain Flavored

Was it:

Regular (Whole or vitamin D)

Reduced fat (2%)

Lowfat (1%)

Fat free (skim)

ADDITIONAL INGREDIENTS: Did the following foods include ingredients not mentioned in the name of the food?

DAY

MEAL

MENU ITEM

ADDITIONAL DETAILS

M

L

Pizza

What kind was it?

Cheese pizza

What was the brand name?

No brand name

Did it include meat?

Yes No

If yes, what kind of meat was it?


Was the meat:

Regular Lean




Did it include any vegetables?

Yes No

If yes, what kind of vegetable was it?


Was the vegetable peeled?

Yes No

What was the form of the vegetable?

Whole Sliced

Diced Shredded

How was the vegetable prepared?

Raw Cooked

If cooked, was it from

Fresh Frozen

Canned Dried

T

B

Ham/Egg Scrambler

Did it include any vegetables?

Yes No

If yes, what kind of vegetable was it?


Was the vegetable peeled?

Yes No

What was the form of the vegetable?

Whole Sliced

Diced Shredded

How was the vegetable prepared?

Raw Cooked

If cooked, was it from

Fresh Frozen

Canned Dried



Public reporting burden for this collection of information is estimated to average 30 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.


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