State, Local and Tribal Agencies

SNAP-Ed Toolkit Submission Form and Scoring Tool (FNS 885 and FNS 886) w/ Screenshots

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

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:

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 %

	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

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.