Information Collection

A3 - Child Nutrition Technology RFA (SLT)

IC 235880 under ICR 201807-0584-003 · OMB 0584-0512.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0512 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form FNS 906 A3 - Child Nutrition Technology RFA (SLT)	Form
Attachment A3 CN Tech - Improve Grant Template - FINAL 7-9-19.docx www.grants.gov	Other-Request for Application Templa
FNS 906 GRANT PROGRAM ACCOUNTING SYSTEM & FINANCIAL CAPABILITY Q FNS-906.pdf www.grants.gov	Form
FNS 908 PERFORMANCE PROGRESS REPORT FNS-908 April 2019.pdf www.grants.gov	Form
AD-1047 DebarmentCert-PrimaryCovered AD-1047 DebarmentCert-PrimaryCovered 4-2022.pdf www.grants.gov	Form
AD-1048 DebarmentCert-PrimaryCovered AD-1048 DebarmentCert-LowerTierCovered 4-2022.pdf www.grants.gov	Form
AD-1049 DrugFreeCert-Alt1 4-2022.pdf AD-1049 DrugFreeCert-Alt1 4-2022.pdf www.grants.gov	Form
AD-1050 DrugFreeCert-Alt2 - 4-2022.pdf AD-1050 DrugFreeCert-Alt2 - 4-2022.pdf www.grants.gov	Form
AD-1052 DrugFreeCert-FedFY 4-2022.pdf AD-1052 DrugFreeCert-FedFY 4-2022.pdf www.grants.gov	Form
SF 425 Screenshots FederalFinancialReport SF-425 Screenshots.pdf www.fprs.gov	Form
SF 425 FederalFinancialReport SF425_2_0-V2.0 exp 2-2022.pdf www.grants.gov	Form
Award Terms and Conditions - Generic - 2.21.2019.docx Award Terms and Conditions - Generic - 2.21.2019.docx	IC Document
AD_3030_2_0-V2.0.pdf AD 3030	IC Document
SF424_2_1-V2.1.pdf SF 424	IC Document
SF424A-V1.0.pdf SF 424A	IC Document
SF424B-V1.1.pdf SF 424B	IC Document
SF424C_2_0-V2.0.pdf SF 424C	IC Document
SF424D-V1.1.pdf SF 424D	IC Document
SFLLL_1_2-V1.2.pdf SF LLL	IC Document

IC Title:

A3 - Child Nutrition Technology RFA (SLT)

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

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
Form	FNS 906	GRANT PROGRAM ACCOUNTING SYSTEM & FINANCIAL CAPABILITY QUESTIONNAIRE	FNS-906.pdf	www.grants.gov	Yes	Yes	Fillable Fileable Signable
Form	FNS 908	PERFORMANCE PROGRESS REPORT	FNS-908 April 2019.pdf	www.grants.gov	Yes	Yes	Fillable Fileable Signable
Form	AD-1047	DebarmentCert-PrimaryCovered	AD-1047 DebarmentCert-PrimaryCovered 4-2022.pdf	www.grants.gov	Yes	Yes	Fillable Fileable Signable
Form	AD-1048	DebarmentCert-PrimaryCovered	AD-1048 DebarmentCert-LowerTierCovered 4-2022.pdf	www.grants.gov	Yes	Yes	Fillable Fileable Signable
Form	AD-1049	DrugFreeCert-Alt1 4-2022.pdf	AD-1049 DrugFreeCert-Alt1 4-2022.pdf	www.grants.gov	Yes	Yes	Fillable Fileable Signable
Form	AD-1050	DrugFreeCert-Alt2 - 4-2022.pdf	AD-1050 DrugFreeCert-Alt2 - 4-2022.pdf	www.grants.gov	Yes	Yes	Fillable Fileable Signable
Form	AD-1052	DrugFreeCert-FedFY 4-2022.pdf	AD-1052 DrugFreeCert-FedFY 4-2022.pdf	www.grants.gov	Yes	Yes	Fillable Fileable Signable
Form	SF 425 Screenshots	FederalFinancialReport	SF-425 Screenshots.pdf	www.fprs.gov	Yes	Yes	Fillable Fileable Signable
Form	SF 425	FederalFinancialReport	SF425_2_0-V2.0 exp 2-2022.pdf	www.grants.gov	Yes	Yes	Fillable Fileable Signable
Other-Request for Application Template			Attachment A3 CN Tech - Improve Grant Template - FINAL 7-9-19.docx	www.grants.gov	Yes	Yes	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records

Title: USDA e-Authentication Service

FR Citation: 77 FR 15024

Number of Respondents: 30

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	288	288
Annual IC Time Burden (Hours)	1,228	1,228
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Award Terms and Conditions - Generic - 2.21.2019.docx	Award Terms and Conditions - Generic - 2.21.2019.docx	04/30/2019
AD 3030	AD_3030_2_0-V2.0.pdf	05/29/2019
SF 424	SF424_2_1-V2.1.pdf	05/29/2019
SF 424A	SF424A-V1.0.pdf	05/29/2019
SF 424B	SF424B-V1.1.pdf	05/29/2019
SF 424C	SF424C_2_0-V2.0.pdf	05/29/2019
SF 424D	SF424D-V1.1.pdf	05/29/2019
SF LLL	SFLLL_1_2-V1.2.pdf	05/29/2019

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