Evaluation of the Direct Certification with Medicaid for Free and Reduced-Price (DCM-F/RP) Meals Demonstration

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
ICR Nonsubstantive Change Memo - DCMFRP Final.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2019-04-03	Available
D1 DCM-FRP Burden Table 2019.xlsx	Supplementary Document	Uploaded 2019-04-03	Available
50305 DCM FRP_OMB PART B Final.docx	Supporting Statement B	Uploaded 2017-06-20	Available
50305 DCM FRP_OMB PART A Final.docx	Supporting Statement A	Uploaded 2017-06-20	Available
H.2 Relevant Documents.docx	Supplementary Document	Uploaded 2017-06-16	Available
H.1 Relevant Documents.docx	Supplementary Document	Uploaded 2017-06-16	Available
G NASS Comments.docx	Supplementary Document	Uploaded 2017-06-16	Available
E DCM-FRP Burden Table.xlsx	Supplementary Document	Uploaded 2017-06-16	Available
D DCM-FRP Confidentiality Pledges_clean.docx	Supplementary Document	Uploaded 2017-06-16	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
227123	Businesses (Vendors)	Other-Appendix A-3.a Detailed Site Visit Interview Protocol: Sta	Unchanged
227122	State, Local and Tribabl Government (CN Agency Staff, State Medicaid Agency Staff, Other State Agency Staff, School District) - Non-Response	Other-Non-Respondents Burden Instrument	Modified
227121	State, Local, and Tribal Government (CN Agency Staff, State Medicaid Agency Staff, Other State Agency Staff, and School District Staff)	Other-Appendix A-2 Site Visit Scheduling Call Protocol	Modified

ICR Details

OMB Control No: 0584-0630	ICR Reference No: 201904-0584-001
Status: Historical Active	Previous ICR Reference No: 201706-0584-001
Agency/Subagency: USDA/FNS	Agency Tracking No: Change Request Memo for 2019
Title: Evaluation of the Direct Certification with Medicaid for Free and Reduced-Price (DCM-F/RP) Meals Demonstration
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 06/17/2019
	Date Received in OIRA: 04/17/2019
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2020	12/31/2020	12/31/2020
Responses	1,552	0	1,105
Time Burden (Hours)	1,966	0	1,174
Cost Burden (Dollars)	0	0	0

---

Abstract: USDA FNS seeks approval to conduct data collection as part of the Evaluation of the Direct Certification with Medicaid for Free and Reduced-Price Meals Demonstration. The study will help FNS understand implementation and demonstration's effectiveness in improving certification and participation outcomes as well as savings and costs in administrative time and labor. At this time, FNS is submitting a nonsubstantive request for this collection to extend the data collection for this study for SY 2018-2019.

---

Authorizing Statute(s): PL: Pub.L. 108 - 265 104 Name of Law: Child Nutrition and WIC Reauthorization Act of 2004
   PL: Pub.L. 111 - 296 103 Name of Law: The Healthy, Hunger-Free Kids Act of 2010 (HHFKA)
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 11526	02/24/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 34275	07/24/2017
Did the Agency receive public comments on this ICR? Yes

---

Number of Information Collection (IC) in this ICR: 3

table that charts list of burden

IC Title	Form No.	Form Name
State, Local, and Tribal Government (CN Agency Staff, State Medicaid Agency Staff, Other State Agency Staff, and School District Staff)
Businesses (Vendors)
State, Local and Tribabl Government (CN Agency Staff, State Medicaid Agency Staff, Other State Agency Staff, School District) - Non-Response

---

ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	1,552	1,105	0	447	0	0
Annual Time Burden (Hours)	1,966	1,174	0	792	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This information collection is currently approved with 1,174 burden hours and 1,105 responses. FNS wishes to collect the administrative data and cost logs from the state agency staff for the 2018-2019 school year. FNS estimates that this program change will increase the burden for this collection by 792 hours and 447 responses. With this request, the burden for this collection will now be 1,966 burden hours and 1,552 responses.

---

Annual Cost to Federal Government: $784,632

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 04/17/2019

---