Information Collection

State and Local Burden - SA, SFA/LEA/Schools

IC 2879 under ICR 202307-0584-009 · OMB 0584-0006.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0006 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment N1. Off-site Assessment Tool.pdf	Other-Attachment N1 Off-site Assessm
Attachment N1. Off-site Assessment Tool.pdf	Other-Attachment N1 Off-site Assessm
Attachment N2. On-site Assessment Tool.pdf	Other-Attachment N2 On-site Assessme
Attachment N2. On-site Assessment Tool.pdf	Other-Attachment N2 On-site Assessme
Attachment N3. Site Selection Worksheet.pdf	Other-Attachment N3 Site Selection W
Attachment N3. Site Selection Worksheet.pdf	Other-Attachment N3 Site Selection W
Attachment N4.Statistical Sample Generator.pdf	Other-Attachment N4 Statistical Samp
Attachment N4.Statistical Sample Generator.pdf	Other-Attachment N4 Statistical Samp
Attachment N5. Meal Compliance Risk Assessment Tool.pdf	Other-Attachment N5 Meal Compliance
Attachment N5. Meal Compliance Risk Assessment Tool.pdf	Other-Attachment N5 Meal Compliance
Attachment N6. Dietary Specifications Assessment Tool.pdf	Other-Attachment N6 Dietary Specific
Attachment N6. Dietary Specifications Assessment Tool.pdf	Other-Attachment N6 Dietary Specific
Attachment N7. Nutrient Analysis and Validation Checklist.pdf	Other-Attachment N7 Nutrient Analysi
Attachment N7. Nutrient Analysis and Validation Checklist.pdf	Other-Attachment N7 Nutrient Analysi
Attachment N8. Nutrient Analysis Protocols.pdf	Other-Attachment N8 Nutrient Analysi
Attachment N8. Nutrient Analysis Protocols.pdf	Other-Attachment N8 Nutrient Analysi
Attachment N9. Resource Management Comprehensive Review Form.pdf	Other-Attachment N9 Resource Managem
Attachment N9. Resource Management Comprehensive Review Form.pdf	Other-Attachment N9 Resource Managem
Attachment N10. Resource Management Risk Indicator Tool.pdf	Other-Attachment N10 Resource Manage
Attachment N10. Resource Management Risk Indicator Tool.pdf	Other-Attachment N10 Resource Manage
Attachment N11. Fiscal Action Workbook.xlsx	Other-Attachment N11 Fiscal Action W
Attachment N11. Fiscal Action Workbook.xlsx	Other-Attachment N11 Fiscal Action W
Attachment N12. Non-reimbursable Meal Allocation Form.pdf	Other-Attachment N12 Non-reimbursabl
Attachment N12. Non-reimbursable Meal Allocation Form.pdf	Other-Attachment N12 Non-reimbursabl
Attachment N13. School Data and Meal Pattern Error Form (S-1).pdf	Other-Attachment N13 School Data and
Attachment N13. School Data and Meal Pattern Error Form (S-1).pdf	Other-Attachment N13 School Data and
Attachment N14. Other Meal Claim Errors (S-2).pdf	Other-Attachment N14 Other Meal Clai
Attachment N14. Other Meal Claim Errors (S-2).pdf	Other-Attachment N14 Other Meal Clai
Attachment N15. Eligibility and Certification and Benefit Issuance Error Worksheet.pdf	Other-Attachment N15 Eligibility Cer
Attachment N15. Eligibility and Certification and Benefit Issuance Error Worksheet.pdf	Other-Attachment N15 Eligibility Cer
Attachment N16. Other Eligibility Certification and Benefit Issuance Errors Worksheet (SFA-2).pdf	Other-Attachment N16 Other Eligibili
Attachment N16. Other Eligibility Certification and Benefit Issuance Errors Worksheet (SFA-2).pdf	Other-Attachment N16 Other Eligibili
Attachment N17. SFA Data Summary Form (SFA-3).pdf	Other-Attachment N17 SFA Data Summar
Attachment N17. SFA Data Summary Form (SFA-3).pdf	Other-Attachment N17 SFA Data Summar
Attachment N18. Special Provisions Non-Base Year and CEP Claiming Percentage Funding Level Summary Form SFA-1A.pdf	Other-Attachment N18 Special Provisi
Attachment N18. Special Provisions Non-Base Year and CEP Claiming Percentage Funding Level Summary Form SFA-1A.pdf	Other-Attachment N18 Special Provisi
Attachment N19. Community Eligibility Provision ISP and Claiming Percentage Validation Worksheet (SFA-2A).pdf	Other-Attachment N19 Community Eligi
Attachment N19. Community Eligibility Provision ISP and Claiming Percentage Validation Worksheet (SFA-2A).pdf	Other-Attachment N19 Community Eligi
Attachment N20. Seamless Summer Option School Data and Meal Pattern Error Form (SSO S-1).pdf	Other-Attachment N20 Seamless Summer
Attachment N20. Seamless Summer Option School Data and Meal Pattern Error Form (SSO S-1).pdf	Other-Attachment N20 Seamless Summer
Attachment N21. Seamless Summer Option Eligibility Certification Form (SSO S-2).pdf	Other-Attachment N21 Seamless Summer
Attachment N21. Seamless Summer Option Eligibility Certification Form (SSO S-2).pdf	Other-Attachment N21 Seamless Summer
Attachment N22. Supplemental Seamless Summer Option Administrative Review Form.pdf	Other-Attachment N22 Supplemental Se
Attachment N22. Supplemental Seamless Summer Option Administrative Review Form.pdf	Other-Attachment N22 Supplemental Se
Attachment N23. Supplemental Afterschool Snacks Administrative Review Form.pdf	Other-Attachment N23 Supplemental Af
Attachment N23. Supplemental Afterschool Snacks Administrative Review Form.pdf	Other-Attachment N23 Supplemental Af
Attachment N24. Supplemental Special Milk Program Administrative Review Form.pdf	Other-Attachment N24 Supplemental Sp
Attachment N24. Supplemental Special Milk Program Administrative Review Form.pdf	Other-Attachment N24 Supplemental Sp
Attachment N25. Infant and Pre-K Meal Pattern On-Site Validation Checklist.pdf	Other-Attachment N25 Infant and Pre-
Attachment N25. Infant and Pre-K Meal Pattern On-Site Validation Checklist.pdf	Other-Attachment N25 Infant and Pre-
Attachment C. Form FNS-640 Administrative Review Data Report.pdf Attachment C Form FNS-640 Administrative Review Data Report (OMB# 0584-0594)	IC Document
Attachment C. Form FNS-640 Administrative Review Data Report.pdf Attachment C Form FNS-640 Administrative Review Data Report (OMB# 0584-0594)	IC Document
Attachment D. Food Programs Reporting System (FPRS) Home Screen with OMB Information and Public Burden Statement.pdf Attachment D OMB# 0584-0594 Food Programs Reporting System (FPRS) Home Screen with OMB Information and Public Burden Statement	IC Document
Attachment D. Food Programs Reporting System (FPRS) Home Screen with OMB Information and Public Burden Statement.pdf Attachment D OMB# 0584-0594 Food Programs Reporting System (FPRS) Home Screen with OMB Information and Public Burden Statement	IC Document
Attachment E. FNS-10 Report of School Operations.pdf Attachment E Form FNS-10 Report of School Operations (OMB# 0584-0594)	IC Document
Attachment E. FNS-10 Report of School Operations.pdf Attachment E Form FNS-10 Report of School Operations (OMB# 0584-0594)	IC Document
Attachment F. FNS-13 Annual Report of State Revenue Matching.pdf Attachment F Form FNS-13 Annual Report of State Revenue Matching (OMB# 0584-0594)	IC Document
Attachment F. FNS-13 Annual Report of State Revenue Matching.pdf Attachment F Form FNS-13 Annual Report of State Revenue Matching (OMB# 0584-0594)	IC Document
Attachment G. FNS-828 School Food Authority Paid Lunch Price Report.pdf Attachment G Form FNS-828 School Food Authority Paid Lunch Price Report (OMB# 0584-0594)	IC Document
Attachment G. FNS-828 School Food Authority Paid Lunch Price Report.pdf Attachment G Form FNS-828 School Food Authority Paid Lunch Price Report (OMB# 0584-0594)	IC Document
Attachment H. FNS-777 Financial Status Report.pdf Attachment H Form FNS-777 Financial Status Report (OMB# 0584-0594)	IC Document
Attachment H. FNS-777 Financial Status Report.pdf Attachment H Form FNS-777 Financial Status Report (OMB# 0584-0594)	IC Document
Attachment M. Administrative Review Guidance Manual 2018_2019.pdf Attachment M Administrative Review Manual	IC Document
Attachment M. Administrative Review Guidance Manual 2018_2019.pdf Attachment M Administrative Review Manual	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

State and Local Burden - SA, SFA/LEA/Schools

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 7 CFR 210.18(i)(3) 7 CFR 210.20(b)(7) 7 CFR 210.19(c) 7 CFR 210.18(o) 7 CFR 210.20(b)(10) 7 CFR 210.19(b) 7 CFR 210.20(b)(12) 7 CFR 210.14(e)(7) 7 CFR 210.15(b)(1) 7 CFR 210.15(b)(2)(3) 7 CFR 210.13(b & c) 7 CFR 210.20(b)(14) 7 CFR 210.8(a)(5) 7 CFR 210.15(b)(2) 7 CFR 210.7(d)(2) 7 CFR 210.18(c-h) 7 CFR 210.13(b) 7 CFR 210.18(h)(2)(iv) 7 CFR 210.31e(2),e(3) 7 CFR 210 7 CFR 210.11(b)(2) 7 CFR 210.15(a)(7)/ 7 CFR 210.8(a)(5)/ 7 CFR 210.5(d)(2)(ii) 7 CFR 210.5 7 CFR 210.20(b)(3) 7 CFR 210.17 (g) & (h) 7 CFR 210.20(b)(6) 7 CFR 210.5(d)(2)(ii) 7 CFR 210.9(b)(21),(c)(7) 7 CFR 210.15(a)(3) 7 CFR 210.20(a)(7) 7 CFR 210.15(a)(1) &210.8(b)&(c) 7 CFR 210.15(b)(1) 7 CFR 210.18(j)(2) 7 CFR 210.15(a)(8) 7 CFR 210.14(e) 7 CFR 210.20(b)(1 & 2) 7 CFR 210.23(c) 7 CFR 210.18(f)(k,l,m,o) 7 CFR 210.15(b)(4) 7 CFR 210.9(b)(18 & 20) 7 CFR 210.9(a & b) 7 CFR 210.15(b)(6) 7 CFR 210.14(f) 7 CFR 210.15(b)(7) & (b)(8) 7 CFR 210.30(g) 7 CFR 210.15(b)(9) 7 CFR 210.31(f) 7 CFR 210.10(m) 7 CFR 210.11(b)(2) 7 CFR 210.9(b)(19) 7 CFR 210.31(d)(2),(3), e(2), e(3) 7 CFR 210.19(f) 7 CFR 210.15(a)(2) & (4) 7 CFR 210.18(m)(1)

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Electronic Capability
Other-Attachment N1 Off-site Assessment Tool	Attachment N1. Off-site Assessment Tool.pdf	No	Paper Only
Other-Attachment N2 On-site Assessment Tool	Attachment N2. On-site Assessment Tool.pdf	No	Paper Only
Other-Attachment N3 Site Selection Worksheet	Attachment N3. Site Selection Worksheet.pdf	No	Paper Only
Other-Attachment N4 Statistical Sample Generator	Attachment N4.Statistical Sample Generator.pdf	No	Paper Only
Other-Attachment N5 Meal Compliance Risk Assessment Tool	Attachment N5. Meal Compliance Risk Assessment Tool.pdf	No	Paper Only
Other-Attachment N6 Dietary Specifications Assessment Tool	Attachment N6. Dietary Specifications Assessment Tool.pdf	No	Paper Only
Other-Attachment N7 Nutrient Analysis and Validation Checklist	Attachment N7. Nutrient Analysis and Validation Checklist.pdf	No	Paper Only
Other-Attachment N8 Nutrient Analysis Protocols	Attachment N8. Nutrient Analysis Protocols.pdf	No	Paper Only
Other-Attachment N9 Resource Management Comprehensive Review Form	Attachment N9. Resource Management Comprehensive Review Form.pdf	No	Paper Only
Other-Attachment N10 Resource Management Risk Indicator Tool	Attachment N10. Resource Management Risk Indicator Tool.pdf	No	Paper Only
Other-Attachment N11 Fiscal Action Workbook	Attachment N11. Fiscal Action Workbook.xlsx	No	Paper Only
Other-Attachment N12 Non-reimbursable Meal Allocation Form	Attachment N12. Non-reimbursable Meal Allocation Form.pdf	No	Paper Only
Other-Attachment N13 School Data and Meal Pattern Error Form (S-1)	Attachment N13. School Data and Meal Pattern Error Form (S-1).pdf	No	Paper Only
Other-Attachment N14 Other Meal Claim Errors (S-2)	Attachment N14. Other Meal Claim Errors (S-2).pdf	No	Paper Only
Other-Attachment N15 Eligibility Certification and Benefit Issuance Error Worksheet (SFA-1)	Attachment N15. Eligibility and Certification and Benefit Issuance Error Worksheet.pdf	No	Paper Only
Other-Attachment N16 Other Eligibility Certification and Benefit Issuance Errors Worksheet (SFA-2)	Attachment N16. Other Eligibility Certification and Benefit Issuance Errors Worksheet (SFA-2).pdf	No	Paper Only
Other-Attachment N17 SFA Data Summary Form (SFA-3)	Attachment N17. SFA Data Summary Form (SFA-3).pdf	No	Paper Only
Other-Attachment N18 Special Provisions Non-Base Year and CEP Claiming Percentage/Funding Level Summary Form (SFA-1A)	Attachment N18. Special Provisions Non-Base Year and CEP Claiming Percentage Funding Level Summary Form SFA-1A.pdf	No	Paper Only
Other-Attachment N19 Community Eligibility Provision ISP and Claiming Percentage Validation Worksheet (SFA-2A)	Attachment N19. Community Eligibility Provision ISP and Claiming Percentage Validation Worksheet (SFA-2A).pdf	No	Paper Only
Other-Attachment N20 Seamless Summer Option School Data and Meal Pattern Error Form (SSO S-1)	Attachment N20. Seamless Summer Option School Data and Meal Pattern Error Form (SSO S-1).pdf	No	Paper Only
Other-Attachment N21 Seamless Summer Option Eligibility Certification Form (SSO S-2)	Attachment N21. Seamless Summer Option Eligibility Certification Form (SSO S-2).pdf	No	Paper Only
Other-Attachment N22 Supplemental Seamless Summer Option Administrative Review Form	Attachment N22. Supplemental Seamless Summer Option Administrative Review Form.pdf	No	Paper Only
Other-Attachment N23 Supplemental Afterschool Snacks Administrative Review Form	Attachment N23. Supplemental Afterschool Snacks Administrative Review Form.pdf	No	Paper Only
Other-Attachment N24 Supplemental Special Milk Program Administrative Review Form	Attachment N24. Supplemental Special Milk Program Administrative Review Form.pdf	No	Paper Only
Other-Attachment N25 Infant and Pre-K Meal Pattern On-Site Validation Checklist	Attachment N25. Infant and Pre-K Meal Pattern On-Site Validation Checklist.pdf	No	Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 115,935

Number of Respondents for Small Entity: 115,499

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 96 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	47,631,996	0	47,631,996
Annual IC Time Burden (Hours)	9,808,701	247	9,808,454
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment C Form FNS-640 Administrative Review Data Report (OMB# 0584-0594)	Attachment C. Form FNS-640 Administrative Review Data Report.pdf	07/28/2023
Attachment D OMB# 0584-0594 Food Programs Reporting System (FPRS) Home Screen with OMB Information and Public Burden Statement	Attachment D. Food Programs Reporting System (FPRS) Home Screen with OMB Information and Public Burden Statement.pdf	07/28/2023
Attachment E Form FNS-10 Report of School Operations (OMB# 0584-0594)	Attachment E. FNS-10 Report of School Operations.pdf	07/28/2023
Attachment F Form FNS-13 Annual Report of State Revenue Matching (OMB# 0584-0594)	Attachment F. FNS-13 Annual Report of State Revenue Matching.pdf	07/28/2023
Attachment G Form FNS-828 School Food Authority Paid Lunch Price Report (OMB# 0584-0594)	Attachment G. FNS-828 School Food Authority Paid Lunch Price Report.pdf	07/28/2023
Attachment H Form FNS-777 Financial Status Report (OMB# 0584-0594)	Attachment H. FNS-777 Financial Status Report.pdf	07/28/2023
Attachment M Administrative Review Manual	Attachment M. Administrative Review Guidance Manual 2018_2019.pdf	07/28/2023

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.