Information Collection

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

IC 226899 under ICR 202106-0584-003 · OMB 0584-0530.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0530 can be found here:

2022-08-23 - No material or nonsubstantive change to a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
B1. (Instrument A5) SFA Request for E-Records_Part A Prior SY (Non-CEP Schools for Household Sampling)_v7.docx	Other-B1. (Instrument A5) SFA Reques
B3. (Instrument A8) SFA Request for E-Records_Part B Current SY (Non-CEP Schools for Household Sampling)_v6.docx	Other-B3. (Instrument A8) SFA Reques
B8. (Instrument A1) Application Data Abstraction Form_v4.docx	Other-B8. (Instrument A1) Applicatio
B9. (Instrument A2) SFA Request for E-Records (CEP Schools for ISP Data Abstraction)_v5.docx	Other-B9. (Instrument A2) SFA Reques
B11. (Instrument A10) SFA Meal Participation Data Request_v4.docx	Other-B11. (Instrument A10) SFA Meal
B12. (Instrument B3) SFA Director Web Survey_v6.docx	Other-B12. (Instrument B3) SFA Direc
B13. (Instrument B1) SFA Pre Data Collection Visit_Questionnaire_v6.docx	Other-B13. (Instrument B1) SFA Pre D
B14. (Instrument B5) School_Pre Data Collection Visit_Questionnaire_v4.docx	Other-B14. (Instrument B5) School_Pr
B15. (Instrument D1) School Meal Count Verification Form_v5.docx	Other-B15. (Instrument D1) School Me
B16. (Instrument D3) SFA Meal Claim Reimbursement Verification Form_all schools_v4.docx	Other-B16. (Instrument D3) SFA Meal
B17. (Instrument D4) State Meal Claim Data Request_v6.docx	Other-B17. (Instrument D4) State Mea
B18. (Instrument C1). Meal Observation Booklet_v4.pdf	Other-B18. (Instrument C1). Meal Obs
C1. (Recruitment 003) Official Notification from Rgl Liaisons to State Dir_v6.docx	Other-C1. (Recruitment 003) Official
C2. (Recruitment 004) SFA Study Notification Template from State CN Director_v2.docx	Other-C2. (Recruitment 004) SFA Stud
C3. (Recruitment 005) SFA Study Notification and Data Request_v5.docx	Other-C3. (Recruitment 005) SFA Stud
C4. (Recruitment 006) SFA School Data Verification Reference Guide_v5.docx	Other-C4. (Recruitment 006) SFA Scho
C6. (Recruitment 007) SFA FU DiscGuide (Study Notification and School Data Verification)_v7.docx	Other-C6. (Recruitment 007) SFA FU D
C7. (Recruitment 008) Automated Email to Confirm Receipt of School Data_v5.docx	Other-C7. (Recruitment 008) Automate
C8. (Recruitment 009) SFA Confirmation and Next Steps Email_v7.docx	Other-C8. (Recruitment 009) SFA Conf
C9. (Recruitment 010) SFA School Sample Notification Email_v7.docx	Other-C9. (Recruitment 010) SFA Scho
C10. (Recruitment 012) Email Notification Template from SFA to Schools_v6.docx	Other-C10. (Recruitment 012) Email N
C11. (Recruitment 011) SFA Follow Up Discussion Guide (School Sample Notification)_v7.docx	Other-C11. (Recruitment 011) SFA Fol
C12. (Recruitment 013) School Study Notification Letter_v7.docx	Other-C12. (Recruitment 013) School
C13. (Recruitment 014) School Follow Up Discussion Guide_v5.docx	Other-C13. (Recruitment 014) School
C14. (Recruitment 015) School Confirmation Email_v7.docx	Other-C14. (Recruitment 015) School
C15. (Recruitment 016) School Notification of HH Data Collection_v4.docx	Other-C15. (Recruitment 016) School
C17. (Instrument B1a) SFA Data Collection Initial Visit Contact Email_v3.docx	Other-C17. (Instrument B1a) SFA Data
C18. (Instrument B1b) SFA Data Collection Visit Confirmation Email_v3.docx	Other-C18. (Instrument B1b) SFA Data
C20. (Instrument B5a) School Data Collection Visit Confirmation Email_v2.docx	Other-C20. (Instrument B5a) School D
C29. (Recruitment 100) Recruitment 100_APEC IV_Study Website Crosswalk_v7.docx	Other-C29. (Recruitment 100) Recruit
B19. Meal Observation Pilot Protocol_v2.docx B19. Meal Observation Pilot Protocol_v2	IC Document
B2. (Instrument A6) SFA Reminder for E-Records Part A Prior SY (Non-CEP Schools for Household Sampling)_v6.docx B2. (Instrument A6) SFA Reminder for E-Records Part A Prior SY (Non-CEP Schools for Household Sampling)_v6	IC Document
B4. (Instrument A9) SFA Reminder for E-Records Part B Current SY (Non-CEP Schools for Household Sampling)_v6.docx B4. (Instrument A9) SFA Reminder for E-Records Part B Current SY (Non-CEP Schools for Household Sampling)_v6	IC Document
B10. (Instrument A3) SFA Reminder for E-Records (CEP Schools for ISP Data Abstraction)_v4.docx B10. (Instrument A3) SFA Reminder for E-Records (CEP Schools for ISP Data Abstraction)_v4	IC Document
C5. (Recruitment 024) APEC-IV FAQ for States, SFAs, and Schools_v6.docx C5. (Recruitment 024) APEC-IV FAQ for States, SFAs, and Schools_v6	IC Document
C19. (Instrument B2) SFA Data Collection Visit Reminder Email_v3.docx C19. (Instrument B2) SFA Data Collection Visit Reminder Email_v3	IC Document
C21a. (Instrument B6) School Data Collection Visit Reminder Email_1 month.docx C21a. (Instrument B6) School Data Collection Visit Reminder Email_1 month	IC Document
C21b. (Instrument B6) School Data Collection Visit Reminder Email_ 1 week.docx C21b. (Instrument B6) School Data Collection Visit Reminder Email_ 1 week	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

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

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-B1. (Instrument A5) SFA Request for E-Records_Part A Prior SY (Non-CEP Schools for Household Sampling)_v7	B1. (Instrument A5) SFA Request for E-Records_Part A Prior SY (Non-CEP Schools for Household Sampling)_v7.docx	Yes	Yes	Fillable Fileable
Other-B3. (Instrument A8) SFA Request for E-Records_Part B Current SY (Non-CEP Schools for Household Sampling)_v6	B3. (Instrument A8) SFA Request for E-Records_Part B Current SY (Non-CEP Schools for Household Sampling)_v6.docx	Yes	Yes	Fillable Fileable
Other-B8. (Instrument A1) Application Data Abstraction Form_v4	B8. (Instrument A1) Application Data Abstraction Form_v4.docx	Yes	Yes	Fillable Fileable
Other-B9. (Instrument A2) SFA Request for E-Records (CEP Schools for ISP Data Abstraction)_v5	B9. (Instrument A2) SFA Request for E-Records (CEP Schools for ISP Data Abstraction)_v5.docx	Yes	Yes	Fillable Fileable
Other-B11. (Instrument A10) SFA Meal Participation Data Request_v4	B11. (Instrument A10) SFA Meal Participation Data Request_v4.docx	Yes	Yes	Fillable Fileable
Other-B12. (Instrument B3) SFA Director Web Survey_v6	B12. (Instrument B3) SFA Director Web Survey_v6.docx	Yes	Yes	Fillable Fileable
Other-B13. (Instrument B1) SFA Pre Data Collection Visit_Questionnaire_v6	B13. (Instrument B1) SFA Pre Data Collection Visit_Questionnaire_v6.docx	Yes	Yes	Fillable Fileable
Other-B14. (Instrument B5) School_Pre Data Collection Visit_Questionnaire_v4	B14. (Instrument B5) School_Pre Data Collection Visit_Questionnaire_v4.docx	Yes	Yes	Fillable Fileable
Other-B15. (Instrument D1) School Meal Count Verification Form_v5	B15. (Instrument D1) School Meal Count Verification Form_v5.docx	Yes	Yes	Fillable Fileable
Other-B16. (Instrument D3) SFA Meal Claim Reimbursement Verification Form_all schools_v4	B16. (Instrument D3) SFA Meal Claim Reimbursement Verification Form_all schools_v4.docx	Yes	Yes	Fillable Fileable
Other-B17. (Instrument D4) State Meal Claim Data Request_v6	B17. (Instrument D4) State Meal Claim Data Request_v6.docx	Yes	Yes	Fillable Fileable
Other-B18. (Instrument C1). Meal Observation Booklet_v4	B18. (Instrument C1). Meal Observation Booklet_v4.pdf	No		Paper Only
Other-C1. (Recruitment 003) Official Notification from Rgl Liaisons to State Dir_v6	C1. (Recruitment 003) Official Notification from Rgl Liaisons to State Dir_v6.docx	Yes	Yes	Fillable Fileable
Other-C2. (Recruitment 004) SFA Study Notification Template from State CN Director_v2	C2. (Recruitment 004) SFA Study Notification Template from State CN Director_v2.docx	Yes	Yes	Fillable Fileable
Other-C3. (Recruitment 005) SFA Study Notification and Data Request_v5	C3. (Recruitment 005) SFA Study Notification and Data Request_v5.docx	Yes	Yes	Fillable Fileable
Other-C4. (Recruitment 006) SFA School Data Verification Reference Guide_v5	C4. (Recruitment 006) SFA School Data Verification Reference Guide_v5.docx	Yes	Yes	Fillable Fileable
Other-C6. (Recruitment 007) SFA FU DiscGuide (Study Notification and School Data Verification)_v7	C6. (Recruitment 007) SFA FU DiscGuide (Study Notification and School Data Verification)_v7.docx	No		Paper Only
Other-C7. (Recruitment 008) Automated Email to Confirm Receipt of School Data_v5	C7. (Recruitment 008) Automated Email to Confirm Receipt of School Data_v5.docx	Yes	Yes	Fillable Fileable
Other-C8. (Recruitment 009) SFA Confirmation and Next Steps Email_v7	C8. (Recruitment 009) SFA Confirmation and Next Steps Email_v7.docx	Yes	No	Fillable Fileable
Other-C9. (Recruitment 010) SFA School Sample Notification Email_v7	C9. (Recruitment 010) SFA School Sample Notification Email_v7.docx	Yes	No	Fillable Fileable
Other-C10. (Recruitment 012) Email Notification Template from SFA to Schools_v6	C10. (Recruitment 012) Email Notification Template from SFA to Schools_v6.docx	Yes	Yes	Fillable Fileable
Other-C11. (Recruitment 011) SFA Follow Up Discussion Guide (School Sample Notification)_v7	C11. (Recruitment 011) SFA Follow Up Discussion Guide (School Sample Notification)_v7.docx	No		Paper Only
Other-C12. (Recruitment 013) School Study Notification Letter_v7	C12. (Recruitment 013) School Study Notification Letter_v7.docx	Yes	Yes	Fillable Fileable
Other-C13. (Recruitment 014) School Follow Up Discussion Guide_v5	C13. (Recruitment 014) School Follow Up Discussion Guide_v5.docx	No		Paper Only
Other-C14. (Recruitment 015) School Confirmation Email_v7	C14. (Recruitment 015) School Confirmation Email_v7.docx	Yes	Yes	Fillable Fileable
Other-C15. (Recruitment 016) School Notification of HH Data Collection_v4	C15. (Recruitment 016) School Notification of HH Data Collection_v4.docx	Yes	Yes	Fillable Fileable
Other-C17. (Instrument B1a) SFA Data Collection Initial Visit Contact Email_v3	C17. (Instrument B1a) SFA Data Collection Initial Visit Contact Email_v3.docx	Yes	Yes	Fillable Fileable
Other-C18. (Instrument B1b) SFA Data Collection Visit Confirmation Email_v3	C18. (Instrument B1b) SFA Data Collection Visit Confirmation Email_v3.docx	Yes	Yes	Fillable Fileable
Other-C20. (Instrument B5a) School Data Collection Visit Confirmation Email_v2	C20. (Instrument B5a) School Data Collection Visit Confirmation Email_v2.docx	Yes	Yes	Fillable Fileable
Other-C29. (Recruitment 100) Recruitment 100_APEC IV_Study Website Crosswalk_v7	C29. (Recruitment 100) Recruitment 100_APEC IV_Study Website Crosswalk_v7.docx	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

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: 1,098

Number of Respondents for Small Entity: 83

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 40 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	14,635	14,635
Annual IC Time Burden (Hours)	5,235	5,235
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
B19. Meal Observation Pilot Protocol_v2	B19. Meal Observation Pilot Protocol_v2.docx	02/09/2022
B2. (Instrument A6) SFA Reminder for E-Records Part A Prior SY (Non-CEP Schools for Household Sampling)_v6	B2. (Instrument A6) SFA Reminder for E-Records Part A Prior SY (Non-CEP Schools for Household Sampling)_v6.docx	02/09/2022
B4. (Instrument A9) SFA Reminder for E-Records Part B Current SY (Non-CEP Schools for Household Sampling)_v6	B4. (Instrument A9) SFA Reminder for E-Records Part B Current SY (Non-CEP Schools for Household Sampling)_v6.docx	02/09/2022
B10. (Instrument A3) SFA Reminder for E-Records (CEP Schools for ISP Data Abstraction)_v4	B10. (Instrument A3) SFA Reminder for E-Records (CEP Schools for ISP Data Abstraction)_v4.docx	02/09/2022
C5. (Recruitment 024) APEC-IV FAQ for States, SFAs, and Schools_v6	C5. (Recruitment 024) APEC-IV FAQ for States, SFAs, and Schools_v6.docx	02/09/2022
C19. (Instrument B2) SFA Data Collection Visit Reminder Email_v3	C19. (Instrument B2) SFA Data Collection Visit Reminder Email_v3.docx	02/09/2022
C21a. (Instrument B6) School Data Collection Visit Reminder Email_1 month	C21a. (Instrument B6) School Data Collection Visit Reminder Email_1 month.docx	02/09/2022
C21b. (Instrument B6) School Data Collection Visit Reminder Email_ 1 week	C21b. (Instrument B6) School Data Collection Visit Reminder Email_ 1 week.docx	02/09/2022

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