Information Collection

State, Local and Tribal Agencies

IC 229727 under ICR 202110-0584-001 · OMB 0584-0639.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0639 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appendix 1 - FNS 885 SNAP-Ed Toolkit Scoring Tool Qualtrics Screenshot Version_01Oct2021.docx snapedtoolkit.org/interventions/submit-an-intervention.	Other-Appendix 1 FNS 885 Screenshot
Appendix 2 - FNS 886 SNAP-Ed Toolkit Intervention Submission Form Qualtrics Screenshot Version_01Oct2021.docx snapedtoolkit.org/interventions/submit-an-intervention.	Other-Appendix 2 - FNS 886 SNAP-Ed T
FNS 885 SNAP-ED TOOLKIT INTERVENTION SCORING TOOL Appendix 1.1 FNS 885 Final Draft 10-6-2021.rtf	Form and Instruction
FNS 886 SNAP-ED TOOLKIT INTERVENTION SCORING TOOL Appendix 2.1 FNS 886 Final Draft 10-6-2021.rtf snapedtoolkit.org/interventions/submit-an-intervention.	Form and Instruction

IC Title:

State, Local and Tribal Agencies

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 7 CFR § 272.2(2)(d) (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Appendix 1 FNS 885 Screenshot			Appendix 1 - FNS 885 SNAP-Ed Toolkit Scoring Tool Qualtrics Screenshot Version_01Oct2021.docx	https://snapedtoolkit.org/interventions/submit-an-intervention.	Yes	Yes	Fillable Fileable Signable
Form and Instruction	FNS 885	SNAP-ED TOOLKIT INTERVENTION SCORING TOOL	Appendix 1.1 FNS 885 Final Draft 10-6-2021.rtf		Yes	No	Fillable Printable
Other-Appendix 2 - FNS 886 SNAP-Ed Toolkit Intervention Submission Form Qualtrics Screenshot			Appendix 2 - FNS 886 SNAP-Ed Toolkit Intervention Submission Form Qualtrics Screenshot Version_01Oct2021.docx	https://snapedtoolkit.org/interventions/submit-an-intervention.	Yes	Yes	Fillable Fileable Signable
Form and Instruction	FNS 886	SNAP-ED TOOLKIT INTERVENTION SCORING TOOL	Appendix 2.1 FNS 886 Final Draft 10-6-2021.rtf	https://snapedtoolkit.org/interventions/submit-an-intervention.	Yes	Yes	Fillable Fileable Signable

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: 44

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	53	53
Annual IC Time Burden (Hours)	136	136
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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