State and Local Government

2023 Pulse Survey: Operational Challenges in Child Nutrition Programs

Documents and Forms

Document Name Document Type
Appendix B_2023 .docx Other-Appendix B_2023 Pulse Survey O
Appendix B_2023 .docx Other-Appendix B_2023 Pulse Survey O
Appendix C_Sample Survey Support Email (2).docx Other-Appendix C_Sample Survey Suppo
Appendix C_Sample Survey Support Email (2).docx Other-Appendix C_Sample Survey Suppo
Appendix E_Sample Thank You Emails.docx Appendix E_Sample Thank You Emails IC Document
Appendix E_Sample Thank You Emails.docx Appendix E_Sample Thank You Emails IC Document
Appendix D_Corrected Sample Reminder Emails.docx Appendix D_ Sample Reminder Emails IC Document
Appendix D_Corrected Sample Reminder Emails.docx Appendix D_ Sample Reminder Emails IC Document

Information Collection (IC) Details

IC Title:	State and Local Government	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Appendix B_2023 Pulse Survey Operational Challenges in Child Nutrition Programs			Appendix B_2023 .docx		Yes	Yes	Fillable Printable
Other-Appendix C_Sample Survey Support Email (2)			Appendix C_Sample Survey Support Email (2).docx		Yes	Yes	Fillable Printable

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 15,705	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 20 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	78,301	78,301
Annual IC Time Burden (Hours)	7,258	7,258
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Appendix E_Sample Thank You Emails	Appendix E_Sample Thank You Emails.docx	09/12/2023
Appendix D_ Sample Reminder Emails	Appendix D_Corrected Sample Reminder Emails.docx	09/13/2023

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