B1. Cost Data Worksheet

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Overview

Activity Descriptions
Time Log
Salary Information
Non-labor Cost information
Partner Cost information

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Sheet 1: Activity Descriptions

STATE COST DATA TRACKING LOGS	OMB Control No: 0584-XXXX Expiration Date: XX/XX/20XX
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 planning and implementing the SNAP mobile payment pilot. 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.
State SNAP agency activity	Activity description
[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: Tailor activities based on document review and conversations with sites. The following are examples of costs and activities to include (final topics will be tailored based on discussions with each agency)
Pre-implementation costs
Staff time	- Planning meetings - Training on mobile payments or for supporting retailers or SNAP participants' use of mobile payments. Trainings could include events to educate staff or retailers or developing resources to assist with the implementation of new mobile payment methods. - Coordinating with partners (EBT processors, mobile application developers, payment platforms, technology developers, retailers). Coordination includes ongoing activities to prepare for or implement new mobile payment methods, and should not overlap with trainings. - Troubleshooting would include activities to help retailers, SNAP participants, or other staff to successfully use mobile payments after implementation of the payment method begins. Troubleshooting does not include regular communication about implementation with partners. - Technology procurement or management
Technology costs	- Contracts with vendors to prepare for mobile payments, including EBT processors, mobile application developers, payment platforms, technology developers - Equipment, including new hardware or software updates, to support mobile payment - Fees for using mobile transactions, such as a standard fee and a per transaction fee that may be charged for use of Apple Pay, Google Pay, or Samsung Pay - Other resources for preparing to accept or process mobile payments
Marketing materials and events	- For SNAP participants, mailed flyers announcing the pilot and instructions on how to participate - For retailers, pamphlets, signage, or stickers alerting retailer customers that SNAP mobile payments are accepted - Onsite engagements at stores or community partners promoting SNAP mobile pay and assisting people with setting it up
Other initial implementation costs	- Overhead and operating costs for the agency, may be charged by allocation or percentage rate.
Ongoing implementation costs
Staff time	- Implementation meetings - Providing troubleshooting support to retailers or SNAP participants (call centers) - Coordinating with partners (EBT processors, mobile application developers, payment platforms, technology developers)
Technology costs	- Contracts with vendors to offer mobile payments, including EBT processors, mobile application developers, payment platforms, technology developers - Equipment, including new hardware or software updates, to support mobile payment - Fees for using mobile transactions, such as a standard fee and a per transaction fee that may be charged for use of Apple Pay, Google Pay, or Samsung Pay - Other resources for accepting or processing mobile payments
Marketing materials and events	- For SNAP participants, mailed flyers announcing the pilot and instructions on how to participate - For retailers, pamphlets, signage, or stickers alerting retailer customers that SNAP mobile payments are accepted - Onsite engagements at stores or community partners promoting SNAP mobile pay and assisting people with setting it up
Other ongoing implmentation costs	- Overhead and operating costs for the agency, may be charged by allocation or percentage rate.
Public Burden Statement
This information is being collected to assist the Food and Nutrition Service in evaluating the Supplemental Nutrition Assistance Program (SNAP) Mobile Payment Pilot (MPP). This is a voluntary collection and FNS will use the information to evaluate the implementation, adoption, and scalability of the SNAP MPP. This collection does request personally identifiable information under the Privacy Act of 1974. 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 to average 1 hour 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 for reducing this burden, to: U.S. Department of Agriculture, Food and Nutrition Service, Office of Policy Support, 1320 Braddock Place, 5th Floor, Alexandria, VA 22314 ATTN: PRA (0584-XXXX). Do not return the completed form to this address.

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Sheet 2: Time Log

STATE COST DATA TRACKING LOGS					OMB Control No: 0584-XXXX Expiration Date: XX/XX/20XX
Use this form to keep track of staff hours by month spent planning or implementing the SNAP mobile payment pilot. 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.
Evaluation of SNAP Mobile Payment Pilots		Start of cost period	[month]	[year]
Time Tracking Log		End of cost period	[month]	[year]
[STATE] SNAP AGENCY	Please fill out the month and year of the workbook above. Each workbook should represent one quarter (3 months).
Staffing position	[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: Tailor the drop down list of activities based on the document review and calls with sites. Activity (select from list)	Total hours spent during the month			Notes
		Month 1	Month 2	Month 3
	[select from list]
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Note: Click the plus (+) at left to expand for an additional 30 rows. Please let the study team know if you need additional space.
Dates	Activity
[year]	[select]
2023	Planning or implementation meetings
2024	Training
2025	Coordinating with partners
2026	Technology procurement or management
[month]	Marketing activities
January	Troubleshooting for retailers or SNAP participants
February	Coordinating with FNS or evaluators
March	Other
April
May
June
July
August
September
October
November
December

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Sheet 3: Salary Information

STATE COST DATA TRACKING LOGS						OMB Control No: 0584-XXXX Expiration Date: XX/XX/20XX
Evaluation of SNAP Mobile Payment Pilots		Start of cost period	[month] [year]
Salary Worksheet		End of cost period	[month] [year]
[STATE] SNAP AGENCY
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:	If fringe in dollar amount, basis paid (select from list)	Notes
		[select from list]		[select from list]	[select from list]
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		[select from list]		[select from list]	[select from list]
		[select from list]		[select from list]	[select from list]
Note: Click the plus (+) at left to expand for an additional 30 rows. Please let the study team know if you need additional space.
		[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: We will hide rows 59 to 66 after customizing to each pilot. Basis of Pay		Unit of Fringe
		[select from list]		[select from list]
		Per Hour		Percentage
		Per Week		Dollar Amount
		Biweekly (26 pay periods)
		Bimonthly (24 pay periods)
		Per Month
		Per Year
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. If providing the a dollar amount for the benefits, please provide the amount for the pay basis selected in column F. Do not include staff names.

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Sheet 4: Non-labor Cost information

STATE COST DATA TRACKING LOGS				OMB Control No: 0584-XXXX Expiration Date: XX/XX/20XX
Use this form to record the dollar amount of any non-labor costs incurred in planning or implementing the SNAP mobile payment pilot, including direct costs (e.g., printing and mailing, conference calls, outside contractors, etc.) or indirect costs (e.g., management, human resources, building maintenance, etc.). For indirect costs, please note in the description of costs if indirect costs are charged by a percentage rate or allocation basis.
Evaluation of SNAP Mobile Payment Pilots		Start of cost period	[month] [year]
Other Direct Costs (ODC) Worksheet		End of cost period	[month] [year]
[STATE] SNAP AGENCY
Note: the costs reported in the table below should NOT duplicate the costs reported in the Partner Cost information sheet. These costs should represent State Agency costs alone.
Description of non-labor costs (include direct and indirect costs)	Amount (dollars)	One-time or recurring cost?	[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: Tailor list based on document review and conversations with agency Activity (if applicable)	Notes
Technology
		[select from list]	[select from list]
		[select from list]	[select from list]
		[select from list]	[select from list]
		[select from list]	[select from list]
		[select from list]	[select from list]
Marketing
		[select from list]	[select from list]
		[select from list]	[select from list]
		[select from list]	[select from list]
		[select from list]	[select from list]
		[select from list]	[select from list]
Overhead or operating
		[select from list]	[select from list]
		[select from list]	[select from list]
		[select from list]	[select from list]
		[select from list]	[select from list]
		[select from list]	[select from list]
Other
		[select from list]	Other - please describe
		[select from list]	Other - please describe
		[select from list]	Other - please describe
		[select from list]	Other - please describe
		[select from list]	Other - please describe
Note: Click the plus (+) at the bottom of each section header to expand for an additional 5 rows per category. Please let the study team know if you need additional space.
		Timeframe	Technology - activities
		[select from list]	[select from list]
		One-time	Any cost related to accepting or processing SNAP mobile payments
		Recurring	Equipment - Hardware							`
			Equipment - Software
			Fees for mobile transactions
			Other
			Marketing - activities
			[select from list]
			Materials for SNAP participants
			Materials for retailers							`
			In-person marketing actvities
			Other
			Overhead or operating- costs
			[select from list]
			Overhead
			Facilities and utilities							`
			Indirect cost rate or allocation
			Other
			Other - please describe

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Sheet 5: Partner Cost information

STATE COST DATA TRACKING LOGS			OMB Control No: 0584-XXXX Expiration Date: XX/XX/20XX
Use this form to record the dollar amount of any non-labor costs incurred in planning or implementing the SNAP mobile payment pilot, including direct costs (e.g., printing and mailing, conference calls, outside contractors, etc.) or indirect costs (e.g., management, human resources, building maintenance, etc.). For indirect costs, please note in the description of costs if overhead costs are charged by a percentage rate or allocation basis.
Evaluation of SNAP Mobile Payment Pilots	Start of cost period	[month] [year]
Other Direct Costs (ODC) Worksheet	End of cost period	[month] [year]
[STATE] SNAP AGENCY
Description of non-labor costs (include direct and indirect costs)	Amount (dollars)	One-time or recurring cost?	Notes
Partner 1
Labor		[select from list]	Note number of staff and total hours
Other direct costs		[select from list]	Note major expenses
Indirect costs		[select from list]	Note indirect cost rate or allocation plan
Total		[select from list]
Partner 2
Labor		[select from list]
Other direct costs		[select from list]
Indirect costs		[select from list]
Total		[select from list]
Partner 3
Labor		[select from list]
Other direct costs		[select from list]
Indirect costs		[select from list]
Total		[select from list]
Partner 4
Labor		[select from list]
Other direct costs		[select from list]
Indirect costs		[select from list]
Total		[select from list]
Note: Click the plus (+) at the bottom of each section header to expand for an additional 5 rows per category. Please let the study team know if you need additional space.
		Timeframe
		[select from list]
		One-time
		Recurring							`
									`
									`