CN Agency and SFA Directors, Business Managers, Superintendents, Menu Planners, School Nutrition Managers, School Liaisons, and Principals - SLT

I6. POINT OF SALE FORM (GROUP 2)

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POINT OF SALE FORM (GROUP 2)

School Name:

School ID:

Interviewer ID:

Date:

AMPM Source Screen Codes

Mark the times at which POS is available

Mark if availability varies

Mark the proportion of foods sold at POS that is reimbursable for . . .

Breakfast

Lunch

Name of POS

Location of POS (Check if present or describe)

Breakfast

Lunch

Other Times

By day

By week

All

Most

About Half

Small Amount

None

All

Most

About Half

Small Amount

None

31

Vending Machine(s)

□ In cafeteria (indoor or outdoor seating/eating area)

□

□

□

□

□

□

□

□

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32

Vending Machine(s)

□ Outside but near (within 20 feet) cafeteria

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□

□

□

□

□

□

□

□

□

□

□

□

□

□

33

Vending Machine(s)

□ In other location on school grounds

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□

□

□

□

□

□

□

□

□

□

□

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34

Cafeteria line(s) - Reimbursable items only

□

□

□

□

□

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35

Cafeteria line(s) - A La Carte items only

□

□

□

□

□

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36

School Store

□

□

□

□

□

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37

Snack Bar(s) – A La Carte Items only

□

□

□

□

□

□

38

Classroom (breakfast)

□

□

□

39

Cafeteria line(s) – Reimbursable and A La Carte items

□

□

□

□

□

□

□

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40

Class parties

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41

Fundraiser(s)

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42

Teacher(s)

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43

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According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0584-xxxx. The time required to complete this information collection is estimated to average 5 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. All information will be kept private under the Privacy Act to the extent allowed by law. 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 Service, 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.

			Describe how availability varies by day or week (if applicable)
AMPM Source Screen Codes
	Name of POS	Location of POS (Check if describing availability)
31	Vending Machine(s)	□ In cafeteria (indoor or outdoor seating/eating area)
32	Vending Machine(s)	□ Outside but near (within 20 feet) cafeteria
33	Vending Machine(s)	□ In other location on school grounds
34	Cafeteria line(s) - Reimbursable items only	□
35	Cafeteria line(s) - A La Carte items only	□
36	School Store	□
37	Snack Bar(s) – A La Carte Items only	□
38	Classroom (breakfast)	□
39	Cafeteria line(s) – Reimbursable and A La Carte items	□
40	Class parties	□
41	Fundraiser(s)	□
42	Teacher(s)	□
43
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