Appendix I Cost data collection instrument.xlsx

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Overview

Activity Descriptions
Time Log
Salary Information
Non-labor Cost information

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Sheet 1: Activity Descriptions

APPENDIX I. COST DATA TRACKING LOGS	OMB #: 0584-XXXX EXPIRATION DATE: XX/XX/20XX
State child nutrition agency activity	Activity description
The following are examples of topics to include (final topics will be tailored to specific agency roles, based on discussions with each agency)
Initial implementation costs
State and local data matching
Planning and staff training
Data cleaning
Systems upgrades
Coordinating with other agencies
Other initial implementation costs
Ongoing implementation costs
State and local data matching
Staff training
Data cleaning
Systems upgrades
Coordinating with other agencies
Other ongoing implmentation costs
Thank you for completing this form. Your responses will help us understand the costs you incur and the various types of activities you perform when implementing the SNAP child support cooperation requirement. We understand that this task requires the investment of your time and we greatly appreciate your participation. Although we have tried to make these forms flexible and straightforward, we would appreciate any suggestions for improvements. Please contact your liaison with the study team with any questions.

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Sheet 2: Time Log

APPENDIX I. STATE COST DATA TRACKING LOGS					OMB #: 0584-XXXX EXPIRATION DATE: XX/XX/20XX
Evaluation of Child Support Enforcement Cooperation Requirements
Time Tracking Log
[STATE NAME] Child Nutrition Agency Version ([FIRST MONTH]–[LAST MONTH] [YEAR])
Name of agency/division:
Staffing position	Activity (select from list)	Total hours spent during month			Notes
		Month 1	Month 2	Month xx
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Use this form to keep track of staff hours by month spent implementing the SNAP child support cooperation requirement. Additional months or activities can be added by inserting columns or rows. Please record activities separately by staffing position (e.g., if two staff of different positions jointly perform an activity, record this activity on two different rows). Do not include staff names. Record the number of hours spent on each activity by each staffing position in the "total hours spent during month" columns.
Ragland-Greene, Rachelle - FNS: insert the entire statement including the address. 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-xxxx. The time required to complete this information collection is estimated up to 90 minutes 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 to reducing this burden, to the following address: U.S. Department of Agriculture, Food and Nutrition Services, Office of Policy Support, 1320 Braddock Place, Alexandria, VA 22314, ATTN: PRA (0584-xxxx). Do not return the completed form to this address.						[Threaded comment] Your version of Excel allows you to read this threaded comment; however, any edits to it will get removed if the file is opened in a newer version of Excel. Learn more: https://go.microsoft.com/fwlink/?linkid=870924 Comment: Revised PBS to include full statement

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Sheet 3: Salary Information

APPENDIX I. STATE COST DATA TRACKING LOGS					OMB #: 0584-XXXX EXPIRATION DATE: XX/XX/20XX
Evaluation of Child Support Enforcement Cooperation Requirements
Salary Worksheet
[STATE NAME] Child Nutrition Agency Version ([FIRST MONTH]–[LAST MONTH] [YEAR])
Staffing position (include each staff position listed in time log)	Pay rate (dollars)	Basis paid (select from list)	Fringe benefit percentage /amount	Fringe benefits calculated as:	Notes
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Use this form to record the salary information for every staffing position recorded in the Time Log. The pay rate can be entered on any basis listed in column C. Please include fringe benefit cost information. Do not include staff names.

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Sheet 4: Non-labor Cost information

APPENDIX I. STATE COST DATA TRACKING LOGS		OMB #: 0584-XXXX EXPIRATION DATE: XX/XX/20XX
Evaluation of Child Support Enforcement Cooperation Requirements
Other Direct Costs (ODC) Worksheet
[STATE NAME] Child Nutrition Agency Version ([FIRST MONTH]–[LAST MONTH] [YEAR])
Description of overhead costs (include direct and indirect costs)	Amount during this data collection period (dollars)	Notes
Use this form to record the dollar amount of any non-labor costs incurred in implementing the SNAP child support cooperation requirement, including direct costs (e.g., printing and mailing, conference calls, outside contractors, etc.) or indirect costs (e.g., management, human resources, building maintenance, etc.).