Appendix D-1 DCM-FRP Burden Table 2019

D1 DCM-FRP Burden Table 2019.xlsx

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

Appendix D-1 DCM-FRP Burden Table 2019

OMB: 0584-0630

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Responsive Non-Responsive


Respondent Category Type of respondents Instruments [a] Appendix Sample Size (Districts) Sample Size (Individuals) Number of respondents Frequency of response Total Annual responses Hours per response Annual burden (hours) Number of
Non-respondents
Frequency of response Total Annual responses Hours per response Annual burden (hours) Grand Total Annual Burden Estimate (hours) Hourly Wage Rate Total Annualized Cost of Respondent Burden
State Child Nutrition Agency Data Collection
State Government State Child Nutrition Agency Staff Site Visit Letter A-1 NA 15 15 1 15 0.083 1.250 0 0 0 0 0 1.250 $42.33 $52.91
Site Visit Scheduling Call A-2 NA 15 15 1 15 0.500 7.500 0 0 0 0 0 7.500 $42.33 $317.48
Site Visit Preparation Guide A-2a NA 15 15 1 15 0.250 3.750 0 0 0 0 0 3.750 $42.33 $158.74
On-Site Interview A-3a NA 45 45 1 45 1 45 0 0 0 0 0 45 $42.33 $1,904.85
On-Site Observations A-4 NA 30 30 1 30 0.500 15 0 0 0 0 0 15 $42.33 $634.95
Site Visit Follow-Up Telephone Interview Email A-5 NA 15 15 1 15 0.033 0.500 0 0 0 0 0 0.500 $42.33 $21.17
Site Visit Follow-Up Telephone Interview A-6a NA 15 15 1 15 1 15 0 0 0 0 0 15 $42.33 $634.95
Administrative Records Request Email B-1 NA 15 15 2 30 0.033 1 0 0 0 0 0 1 $42.33 $42.33
Administrative Records Request B-2 NA 15 15 2 30 12 360 0 0 0 0 0 360 $42.33 $15,238.80
State Cost Data Collection Email C-1 NA 15 15 4 60 0.033 2 0 0 0 0 0 2 $42.33 $84.66
State Cost Data Collection Tracking Log C-2,
C-3a
NA 15 15 4 60 3 180 0 0 0 0 0 180 $42.33 $7,619.40
State Cost Data Collection Clarification Call C-4 NA 15 15 4 60 0.333 20 0 0 0 0 0 20 $42.33 $846.60
State Child Nutrition Agency Data Collection for 2019


Administrative Records Request Email B-1 NA 15 15 2 30 0.033 1 0 0 0 0 0 1 $42.33 $42.33
Administrative Records Request B-2 NA 15 15 2 30 12 360 0 0 0 0 0 360 $42.33 $15,238.80
State Cost Data Collection Email C-1 NA 15 15 4 60 0.033 2 0 0 0 0 0 2 $42.33 $84.66
State Cost Data Collection Tracking Log C-2,
C-3a
NA 15 15 4 60 3 180 0 0 0 0 0 180 $42.33 $7,619.40
State Cost Data Collection Clarification Call C-4 NA 15 15 4 60 0.333 20 0 0 0 0 0 20 $42.33 $846.60
State Medicaid Agency Data Collection
State Government State Medicaid Agency Staff Site Visit Letter A-1 NA 15 15 1 15 0.083 1.250 0 0 0 0 0 1.250 $42.33 $52.91
Site Visit Scheduling Call A-2 NA 15 15 1 15 0.500 7.500 0 0 0 0 0 7.500 $42.33 $317.48
Site Visit Preparation Guide A-2b NA 15 15 1 15 0.250 3.750 0 0 0 0 0 3.750 $42.33 $158.74
On-Site Interview A-3b NA 45 45 1 45 1 45 0 0 0 0 0 45 $42.33 $1,904.85
On-Site Observations A-4 NA 30 30 1 30 0.500 15 0 0 0 0 0 15 $42.33 $634.95
Site Visit Follow-Up Telephone Interview Email A-5 NA 15 14 1 14 0.033 0.467 1 1 1 0.033 0.033 0.500 $42.33 $21.17
Site Visit Follow-Up Telephone Interview A-6b NA 15 14 1 14 1 14 1 1 1 0.167 0.167 14.167 $42.33 $599.68
State Cost Data Collection Email C-1 NA 15 14 4 56 0.033 1.867 1 1 1 0.033 0.033 1.900 $42.33 $80.43
State Cost Data Collection Tracking Log C-2,
C-3b
NA 15 14 4 56 3 168 1 1 1 0.167 0.167 168.167 $42.33 $7,118.50
State Cost Data Collection Clarification Call C-4 NA 15 14 4 56 0.333 18.667 1 1 1 0.250 0.250 18.917 $42.33 $800.74
State Medicaid Agency Data Collection for 2019


State Cost Data Collection Email C-1 NA 15 14 4 56 0.033 1.867 1 1 1 0.033 0.033 1.900 $42.33 $80.43
State Cost Data Collection Tracking Log C-2,
C-3b
NA 15 14 4 56 3 168 1 1 1 0.167 0.167 168.167 $42.33 $7,118.50
State Cost Data Collection Clarification Call C-4 NA 15 14 4 56 0.333 18.667 1 1 1 0.250 0.250 18.917 $42.33 $800.74
Other State Agency Data Collection
State Government Other State Agency Staff Site Visit Letter A-1 NA 3 3 1 3 0.083 0.250 0 0 0 0 0 0.250 $42.33 $10.58
Site Visit Scheduling Call A-2 NA 3 3 1 3 0.500 1.500 0 0 0 0 0 1.500 $42.33 $63.50
Site Visit Preparation Guide A-2b NA 3 3 1 3 0.250 0.750 0 0 0 0 0 0.750 $42.33 $31.75
On-Site Interview A-3b NA 3 3 1 3 1 3 0 0 0 0 0 3 $42.33 $126.99
State Cost Data Collection Email C-1 NA 3 3 4 12 0.033 0.400 0 0 0 0 0 0.400 $42.33 $16.93
State Cost Data Collection Tracking Log C-2,
C-3b
NA 3 3 4 12 3 36 0 0 0 0 0 36 $42.33 $1,523.88
State Cost Data Collection Clarification Call C-4 NA 3 3 4 12 0.333 4 0 0 0 0 0 4 $42.33 $169.32
Other State Agency Data Collection for 2019


State Cost Data Collection Email C-1 NA 3 3 4 12 0.033 0.400 0 0 0 0 0 0.400 $42.33 $16.93
State Cost Data Collection Tracking Log C-2,
C-3b
NA 3 3 4 12 3 36 0 0 0 0 0 36 $42.33 $1,523.88
State Cost Data Collection Clarification Call C-4 NA 3 3 4 12 0.333 4 0 0 0 0 0 4 $42.33 $169.32
School District Data Collection
Local Government School District Staff Site Visit Letter A-1 34 34 34 1 34 0.083 2.833 0 0 0 0 0 2.833 $41.86 $118.60
Site Visit Scheduling Call A-2 34 34 34 1 34 0.500 17 0 0 0 0 0 17 $41.86 $711.62
Site Visit Preparation Guide A-2c 34 34 34 1 34 0.250 8.500 0 0 0 0 0 8.500 $41.86 $355.81
On-Site Interview A-3c 34 102 102 1 102 1 102 0 0 0 0 0 102 $41.86 $4,269.72
On-Site Observations A-4 34 68 68 1 68 0.500 34 0 0 0 0 0 34 $41.86 $1,423.24
Site Visit Follow-Up Telephone Interview Email A-5 34 34 31 1 31 0.033 1.033 3 1 3 0.033 0.100 1.133 $41.86 $47.44
Site Visit Follow-Up Telephone Interview A-6c 34 34 31 1 31 1 31 3 1 3 0.167 0.500 31.500 $41.86 $1,318.59
State/Local Government Sub-Total
34 195 195 7.86 1,532 1.280 1,961 4 3.5 14 0.121 1.700 1962.40 - $82,975.82
Vendor Data Collection
Business Vendor Staff Telephone Interview Email A-2d NA 2 2 1 2 0.033 0.067 0 0 0 0 0 0.067 $42.25 $2.82
On-Site or telephone Interview A-3a/b NA 4 4 1 4 1 4 0 0 0 0 0 4 $42.25 $169.00
Business Sub-Total
NA 4 4 1.50 6 0.678 4.067 0 0 0 0 0 4.067 $42.25 $171.82

OLD GRAND TOTAL [c]

34 199 199 5.497 1,094 1.072 1,173 4 2.750 11 0.114 1 1,174 - $49,606.05

2019 Subtotal

0 33 33 13.455 444 1.784 792 3 1.000 3 0.150 0 792
$33,541.59

NEW GRAND TOTAL

34 199 199 7.729 1,538 1.277 1,965 4 3.500 14 0.121 1.7 1,966 - $83,147.63



















Notes: NA = Not applicable.

















Due to rounding of the data in this table, the individual components may not appear to sum exactly to the totals.
















[a] Data collection instruments for Child Nutrition, Medicaid, and school district staff are included in appendices. In States where staff of State Agency vendors or third State Agencies play key roles in the DCM-F /RP process, the protocol for Child Nutrition Agency staff or Medicaid Agency staff—depending on which role is most similar—would be tailored for use in interviewing those respondents.


[b] For State government respondents, we used North American Industry Classification System (NAICS) 999200: State Government (SOC Code 11-000) mean wage = $42.33 per hour in computing the cost of respondent burden. For local government respondents, we used NAICS 999300: Local Government (SOC Code 11-000) mean wage = $41.86 per hour. For Business respondents, we used SOC Code 15-0000 (Computer and Mathematical Occupations) mean wage $42.25 per hour in computing the cost of respondent burden. Source: Bureau of Labor Statistics, Occupational Employment Statistics Survey, May 2016. (http://www.bls.gov/oes/current/naics3_999000.htm; https://www.bls.gov/oes/current/oes150000.htm)


[c] State Child Nutrition Agency, State Medicaid Agency, other State Agency, and school district staff are all expected to participate in multiple data collection activities, including the site visits, follow-up interviews, and the completion of cost tracking logs and administrative records requests, where applicable. Each individual is counted only once in the total.


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