Child and Adult Care Food Program (CACFP) National Disqualified List

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form FNS-843 Report of Disqualification from Participation: Institution and Responsible Principals/Individuals	Form and Instruction	Modified	Available
Form FNS-844 Report of Disqualification from Participation - Individually Disqualified Responsible Principal/Individual or Day Care Home Provider	Form	Modified	Available
Form FNS-844 State Agencies	Form	Modified	Repair queued
0584-0584 Supporting Statement for NDL System Final 07.25.23 -2.docx	Supporting Statement A	Uploaded 2023-07-26	Repair queued
0584-0584 Supporting Statement for NDL System Final 07.25.23 -2.docx	Supporting Statement A	Uploaded 2023-07-26	Repair queued
B2 CACFP Authorizing Regulation.docx	Supplementary Document	Uploaded 2019-11-22	Repair queued
B2 CACFP Authorizing Regulation.docx	Supplementary Document	Uploaded 2019-11-22	Repair queued
B1 Authorizing Statute National School Lunch Act 42 USC1766.docx	Supplementary Document	Uploaded 2019-11-22	Repair queued
B1 Authorizing Statute National School Lunch Act 42 USC1766.docx	Supplementary Document	Uploaded 2019-11-22	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
206841	State Agencies	Form and Instruction	Modified	Report of Disqualification from Participation: Institution and Responsible Principals/Individuals
206841	State Agencies	Form	Modified	Report of Disqualification from Participation - Individually Disqualified Responsible Principal/Individual or Day Care Home Provider
206841	State Agencies	Form	Modified

ICR Details

OMB Control No: 0584-0584	ICR Reference No: 202307-0584-006
Status: Historical Active	Previous ICR Reference No: 202203-0584-004
Agency/Subagency: USDA/FNS	Agency Tracking No: 2023 Renewal
Title: Child and Adult Care Food Program (CACFP) National Disqualified List
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/05/2023
Retrieve Notice of Action (NOA)	Date Received in OIRA: 07/31/2023
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2026	36 Months From Approved	08/31/2023
Responses	1,568	0	1,568
Time Burden (Hours)	784	0	784
Cost Burden (Dollars)	0	0	0

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Abstract: This collection is an extension without change of a previously approved collection for which approval is expiring for maintaining the Child and Adult Care Food Program (CACFP) National Disqualified List (NDL) of institutions, day care home providers, and individuals that have been terminated or otherwise disqualified from CACFP participation.

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Authorizing Statute(s): PL: Pub.L. 106 - 224 243(c) Name of Law: Agricultural Risk Protection Act of 2000
   US Code: 42 USC 1766(d)(5)(E)(i) and (ii) Name of Law: Richard B. Russell National School Lunch Act (NSLA)
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 26271	04/28/2023
30-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 48787	07/28/2023
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
State Agencies	FNS-843, FNS-844	Report of Disqualification from Participation - Individually Disqualified Responsible Principal/Individual or Day Care Home Provider ,   Report of Disqualification from Participation: Institution and Responsible Principals/Individuals

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	1,568	1,568	0	0	0	0
Annual Time Burden (Hours)	784	784	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $11,206

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 07/31/2023

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