State, Local, and Tribal Government - State Child Nutrition Agency, SFA, and Schools

APPENDIX B14. (INSTRUMENT B5). SCHOOL PRE DATA COLLECTION VISIT QUESTIONNAIRE

   OMB Number: 0584-0530

  Expiration Date: XX/XX/XXXX

Fourth Access Participation Eligibility and Certification Study Series (APEC IV)
	School Pre Data Collection Visit Questionnaire

Thank you again for your participation in APEC IV, sponsored by the U.S. Department of Agriculture Food and Nutrition Service (USDA FNS).

We are contacting you now to prepare for the data collection visit to the SFA office and your sampled schools. This form is a fillable PDF document that you can save, complete electronically, and submit via email to [INSERT EMAIL ADDRESS].

We kindly request that you submit the School Pre-Visit Questionnaire(s) (as well as the SFA Pre-Visit Questionnaire) by [INSERT DATE}.

You should submit one of these forms for each school participating in the APEC IV study. As a reminder, the list of schools can be found in the body of the email that you received with this form. If we do not receive your completed forms by this date, we will follow up with you by email and/or phone.

The questionnaire is brief, with only 10 questions.

 OMB Number: 0584-XXXX

  Expiration Date: XX/XX/XXXX

Fourth Access Participation Eligibility and Certification Study Series (APEC IV)
	School Pre Data Collection Visit Questionnaire

SECTION A: SCHOOL CONTACT INFORMATION

1. Enter school contact information (this is the point of contact for the data collection visit):

Name of SFA
School Name
School Contact Person Name
Position/Title
Phone Number
Email Address
Street Address
Suite/Room #
City
State
Zip

SECTION B: MEAL OBSERVATION INFORMATION

While we are onsite, we will observe both breakfast and lunch meal service, as applicable. The data collector will record¹ the items in meals that some students take and whether they are claimed as reimbursable. Prior to observation, the data collector will need to meet briefly with the school cafeteria manager to go over logistics for meal observations.

2. Enter school cafeteria manager contact information:

Name
Title
Phone Number
Email Address

To help us plan the visit to this school, please provide as much of the following information about breakfast and lunch meal service at this school as possible.

3. Summary of BREAKFAST

Check here if breakfast is not served at this school

Check here if breakfast is Offer vs Serve (OVS)

Meal Period	Meal Period Start Time	Meal Period End Time	Number of cashiers/ register lines/locations in the meal period	List Location(s) served (e.g., cafeteria, classroom, etc.) in each meal period
1
2
3

4. Summary of LUNCH

Check here if lunch is not served at this school

Check here if lunch is Offer vs Serve (OVS)

Meal Period	Meal Period Start Time	Meal Period End Time	Number of cashiers/ register lines/locations in the meal period	List Location(s) served (e.g., cafeteria, classroom, etc.) in each meal period
1
2
3
4
5

5. Enter comments and/or other information we need to know about conducting meal observations at this school prior to the data collection visit.

SECTION C: MEAL COUNT DATA

During our data collection visit, we will also need to gather school meal count records that this school submitted to the SFA or State for October 2023. During the data collection visit, we will request copies of records of meal counts for October 2023. For data that are stored electronically, we will request a printed hardcopy. If the SFA maintains these records for this school, we can collect it from the SFA intead. There is the option to submit these records electronically via a secure site. Detailed instructions will be provided separately.

6. Do you prefer to provide this information during an in-person data collection visit or electronically via a secure website?

In-person visit

Electronically via a secure website

7. How does this school generate counts of reimburseable meals?

Counts by hand (e.g., a staff member uses a clicker or hardcopy sheet)

Electronic counts at each register or point of service (POS)

A single total across all cash registers or POS

Other specify:

8. Does the school submit meal counts to a secondary or intermediary office or department before it goes to the SFA?

No

Yes – select one below

Meal counts are manually entered

School’s POS sum and submit the count

Other Specify:

9. Enter comments and/or other information we need to know about gathering meal count records at this school prior to the data collection visit.

SECTION D: SITE VISIT LOGISTICS

10. Enter any special instructions or information about access to the school and parking that the data collector needs to know prior to the site visit (e.g., general information, parking requirements, an escort is needed in the building or some other security requirement, hours of operation, special directions, etc.).

THANK YOU FOR COMPLETING
THE SCHOOL PRE DATA COLLECTION-VISIT QUESTIONNAIRE

REMINDER

We included a generic school questionnaire as an attachment via email. Please ‘save as’ a copy for each of your sampled schools.

The SFA and school will receive an email reminder one month
and one week prior to the data collection visit. This email will
include the name and contact information of the data collector.

Thank you again for your participation in APEC IV.

Authority: This information is being collected under the authority of the Healthy, Hunger-Free Kids Act of 2010 (P. L. 111-296), Section 305.

Purpose: The Food and Nutrition Service (FNS) is collecting this information to assess improper payments made in the National School Lunch Program (NSLP) and School Breakfast Program (SBP).

Routine Use: The records in this system may be disclosed to private firms that have contracted with FNS to collect, aggregate, analyze, or otherwise refine records for the purpose of research and reporting to Congress and appropriate oversight agencies, and/or departmental and FNS officials.

Disclosure: Disclosing the information is voluntary, and there are no consequences to you as an individual for not providing the information. 

The System of Records Notice for this information collection is USDA/FNS-8, FNS Studies and Reports, which can be located at https://www.govinfo.gov/content/pkg/FR-1991-04-25/pdf/FR-1991-04-25.pdf (p. 19078).

TEMPORARY NOTE TO REVIEWERS

Following the creation of the study website, the APEC IV study team will work with IT staff to develop a reference guide for SFAs and Schools to submit data electronically, if they select this option. The guide will include the following:

• A summary of the SFA- and school-level data that can be submitted electronically through the secure website.

• Detailed instructions (including screenshots) on using the APEC IV web portal to upload their data.

This information is being collected to provide the Food and Nutrition Service with key information on the annual error rates and improper payments for the school meal programs. This is a voluntary collection and FNS will use the information to examine school meal error rates and inform future APEC studies. This collection requests personally identifiable information under the Privacy Act of 1974. 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 0584-0530. The time required to complete this information collection is estimated to average 0.334 hours (20 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. 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, 1320 Braddock Place, 5th Floor, Alexandria, VA 22306 ATTN: PRA (0584-0530). Do not return the completed form to this address.

1 The term “record” will be replaced with the term “photograph” if the camera method is used at the school.

Questions about completing this form? Contact us as [INSERT EMAIL] or [INSERT NUMBER] 7