Businesses (Vendors)

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

Documents and Forms

Document Name Document Type
A3a DCM-FRP CN Site Visit Protocol.docx Other-Appendix A-3.a Detailed Site V
A3b DCM-FRP Medicaid Site Visit Protocol.docx Other-Appendix A-3.b Detailed Site V
A2d Vendor Phone Interview Email.docx Appendix A-2.d Vendor Telephone Interview Email IC Document

Information Collection (IC) Details

IC Title:	Businesses (Vendors)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Appendix A-3.a Detailed Site Visit Interview Protocol: State Child Nutrition Agency Staff			A3a DCM-FRP CN Site Visit Protocol.docx		No		Paper Only
Other-Appendix A-3.b Detailed Site Visit Interview Protocol: State Medicaid Agency Staff			A3b DCM-FRP Medicaid Site Visit Protocol.docx		No		Paper Only

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records
Title: FNS-8 USDA/FNS Studies and Reports	FR Citation: 56 FR 19078

Number of Respondents: 4	Number of Respondents for Small Entity: 2

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	6	6
Annual IC Time Burden (Hours)	4	4
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Appendix A-2.d Vendor Telephone Interview Email	A2d Vendor Phone Interview Email.docx	06/20/2017

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