Appendix A_Burden Table - Extension for 0654

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Overview

Sample Burden Table - Studies
Sheet2
Sheet3

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Sheet 1: Sample Burden Table - Studies

Respondent Category	Type of respondents (optional)	Instruments	Number of respondents	Frequency of response	Total Annual responses	Hours per response	Annual burden (hours)	Hourly Wage Rate	Total Annualized Cost of Respondent Burden
State Government	SNAP State Agency	Waiver	53	12	636	10	6,360.00	$17.53	$111,490.80
	SNAP State Agency	FFCRA Reporting	53	3	159	3	477.00	$17.53	$8,361.81
	SNAP State Agency	Weekly Oper.Update	53	52	2756	1	2,756.00	$17.53	$48,312.68
									$-
	WIC State Program Staff	FFCRA Reporting	20	1	20	2	40.00	$35.05	$1,402.00
	WIC State Program Staff	MIS Data Pull Form	20	1	20	1.5	30.00	$35.05	$1,051.50
	FMNP State Program Staff	Evaluation Info	22	1	22	2	44.00	$35.05	$1,542.20
	CN State Agency	Review waiver guidance	67	1	67	0.25	16.75	$35.05	$587.09
	CN State Agency	Waiver dev&sub	67	1.94	129.98	1	129.98	$35.05	$4,555.80
	CN State Agency	Waiver pub notice	67	1.94	129.98	0.5	64.99	$35.05	$2,277.90
	CN State Agency	Waiver reporting	67	1.5	100.5	0.5	50.25	$35.05	$1,761.26
Local Government	Food Dist. State Program Staff	Form: FNS292A	60	52	3120	0.25	780.00	$35.05	$27,339.00
								$35.05
Local Government	WIC Local Agency Program Staff	FFCRA Reporting	800	1	800	1	800.00	$35.05	$28,040.00
Respondent	TOTAL		1,349	129.380	7,960	23.000	11,548.97		$236,722.04
								Fully loaded (total * 1.33)=	$314,840.31
Federal Cost	SNAP Administrative Cost Sharing								$168,165.29
	Federal Worker, GS13 Step 1	Waiver Request	1		658	0.25	164.50	$66.07	$10,868.52
	Federal Worker, GS13 Step 1	FFCRA Reporting	1		1406.46	3.0	4,219.38	$66.07	$278,774.44
	Federal Worker, GS13 Step 1	Review FNS292A	1		3120	0.25	780.00	$66.07	$51,534.60
	CN Federal Worker, GS13 Step 1	Waiver Review and Response	1	129.98	129.98	3	389.94	$66.07	$25,763.34
	CN Federal Worker, GS13 Step 1	Review and Maintain Waiver Reports	1	100.5	100.5	1	100.50	$66.07	$6,640.04
	Total								$541,746.21
				Total responses	7,960
				electronic responses	1,289
				percent electronic	16.2%

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Sheet 2: Sheet2

		OMB #	Type of Request	How submitted	Assoc.Docs.
SNAP	Waiver Requests	0584-0083	Information is approved under referenced Information Collection (IC). Waiver requests are submitted via email as needed.	email	(instructions)
SNAP	Evaluation Data/Data Reports	0584-0654	This addresses required reporting under FFCRA.Information submitted via email as needed, per use of waivers.	email	(instructions)
SNAP	Weekly Operational Update	0584-0083	States required to submit this info in their State Plans of operations (approved under the referenced ICR) and required to update FNS of any changes. The current estimate is weekly emails but the frequency could be less. SNAP program staff in 53 state agencies will submit 1 weekly update to their FNS Regional Offices.	email
WIC	Evaluation Data	0584-0654	WIC program staff in 20 state agencies will submit 1 survey per agency reporting on the evaluation data required by FFCRA. Will take about 2 hours per survey.	online form	(form)
WIC	* State MIS data pull		FNS will request states submit a data pull from their MIS systems to help facilitate the evaluation data reporting on the number of WIC participants affected by different waivers. 20 WIC State Agencies impacted. Approx 1.5 hours required per response.		(instructions and form)
FMNP	Evaluation Data	0584-0654	FMNP Program Staff in each of 22 State Agencies will submit 1 State Plan, reporting on the evaluation data required by the FFRCA. It will take each about 2 hours to complete each report.		(form)
CN	State agency review waiver guidance	0584-0654	It is estimated 67 State agencies will review statewide waiver protocol and guidance pertaining to the waiver authority established at Section 12(l) of the NSLA, such as Child Nutrition Program Waiver Request Guidance and Protocol- Revised (Memo code: SP15 CACFP 12 SFSP 05-2018). FNS estimates State agencies will revisit NSLA waiver guidance one time each year, and that it takes approximately 15 minutes for each review of guidance.		instructions
	State agency Waiver development & submission	0584-0654	FNS estimates 67 CN State agencies will request statewide waivers per guidance outlined in Child Nutrition Program Waiver Request Guidance and Protocol- Revised (Memo code: SP15 CACFP 12 SFSP 05-2018) and submit waiver requests.It’s estimated, together, 67 State agencies will develop and request total of 130 statewide waivers of CN Program requirements. Each request will take approx 1 hour to develop and submit to FNS.
	State agency waiver public notice	0584-0654	Each State agency that submits a request is required to provide public notice regarding the request. FNS estimates 67 State agencies will provide 130 public notices associated with statewide waiver requests submitted under Section 12(l) waiver authority, and that it takes 30 minutes (.5 hours) to provide each public notice.
	State agency reporting	0584-0654	Of the total 130 estimated statewide waiver requests, FNS estimates 100 will be approved, and will require State agencies to report on waiver implementation within 1 year of the approval date. It takes approximately 30 minutes (.5 hours) for State agencies to develop and submit evaluation data on statewide waiver implementation.
FD	Commodities Use (FNS292A)	0584-0594	This form is covered under the referenced IC. Food Distribution Program Staff in 60 State Agencies will submit form FNS 292A 52 times (weekly over twelve months). It will take them approximately 15 minutes to complete the form each time.	email	form
WIC	Local Agency Program staff - Report to State		Local Agency staff in about 800 Local WIC agencies will submit 1 survey per agency to FNS. It will take 1 hour to complete and submit each report.	online form	form

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Sheet 3: Sheet3

Respondent Category	Type of respondents (optional)	Instruments	Number of respondents
State Government	SNAP State Agency	Waiver	53
	SNAP State Agency	Data reports	53
	SNAP State Agency	Weekly Opperational Update	53
	WIC State Program Staff	Evaluation Survey	20
	WIC State Program Staff	MIS Data Pull	20
	FMNP State Program Staff	Evaluation Data	22
	CN State Program Staff	Review waiver guidance	67
	CN State Program Staff	Waiver develop& submiss.	67
	CN State Program Staff	Waiver Public Notice	67
Local	WIC	Report to state	800
State	CN State Program Staff	Waiver reporting	67
Local	FD State	FNS292A	60
Respondent	TOTAL		1,349