Appendix H - COVID-19 Statewide Waiver Reporting Tool

OMB Number: 0584-0654
Expiration Date: 01/31/2022

Appendix H
COVID-19 Statewide Waiver Reporting Tool

This information is being collected to assist the Food and Nutrition Service (FNS) to review the performance of state agencies’ and eligible service
providers’ Child Nutrition Program (CNP) operations under waiver authority, as required by Section 12(l) of the Richard B. Russell National School
Lunch Act (NSLA). This is a voluntary collection tool States may use to meet the reporting requirements established in Section 12(l) of the NSLA
and FNS’ guidance, Child Nutrition Program Waiver Request Guidance and Protocol – Revised. FNS uses the information to ensure that waivers
granted improve program operations while maintaining program integrity, as well as review the performance of state agencies’ and eligible service
providers’ CNP operations under waiver authority, as required by the NSLA. This collection does request any personally identifiable information
under the Privacy Act of 1974. Responses will be kept private to the extent provided by law. 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 0584-0654. The time required to complete this information collection is
estimated to average 30 minutes (.5 hours) 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 22314 ATTN: PRA (0584-0654). Please do not return
the completed form to this address.

9. Please summarize the findings associated with the FFVP waiver to allow parental pickup during
SY 19-20. Examples may include an explanation of the challenges the State agency, sponsor, or
site encountered while implementing this waiver.*
Enter your answer

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Option to Report on an Additional Waiver
Please know your State agency is not required report on all the waivers included in this reporting tool at this time. If you
have completed all the reporting that your State agency would like to submit at this time, you may select "submit and log
out now" as your response to the question below and continue to submit the information previously reported. The
reporting tool can be used at a later time to fulfill additional reporting requirements for other waivers that still require
reporting.

10. Would you like to report on an additional waiver now, or submit what has been reported and log
out? You may revisit this reporting tool to submit an additional report(s) later if needed.*

0

Report on an additional waiver

0

Submit and log out now

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56. Describe whether and how this waiver resulted in improved services to Program participants.*
Enter your answer

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Option to Report on an Additional Waiver
Please know your State agency is not required report on all the waivers included in this reporting tool at this time. If you
have completed all the reporting that your State agency would like to submit at this time, you may select "submit and log
out now" as your response to the question below and continue to submit the information previously reported. The
reporting tool can be used at a later time to fulfill additional reporting requirements for other waivers that still require
reporting.

57. Would you like to report on an additional waiver now, or submit what has been reported and log
out? You may revisit this reporting tool to submit an additional report(s) later if needed. *

0

Report on an additional waiver

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Submit and log out now

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Submit