National Farm to School Network's (NFSN) information collection process for the Racial Equity Learning Lab

FNS Fast Track Clearance for the Collection of Routine Customer Feedback

Appendix E - Follow Up Survey

National Farm to School Network's (NFSN) information collection process for the Racial Equity Learning Lab

OMB: 0584-0611

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OMB Number: 0584-0611

Expiration Date: 11/30/2025

OMB BURDEN STATEMENT: This information is being collected to determine what additional resources and information are needed to advance racial equity in farm to school work. This is a voluntary collection and FNS will use the information to carry out EO 14058 “Advancing Racial Equity and Support for Underserved Communities Through the Federal Government” to ensure government is carrying out more equitable and effective services. This collection does not request any 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 0584-0611. The time required to complete this information collection is estimated to average less than one hour per response, including the time for reviewing instructions and answering the survey questions. 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 22306 ATTN: PRA (0584-0611). Do not return the completed form to this address.

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Appendix E: Follow Up Survey  (6 months after participating in the Lab)


Demographic Questions:

  1. Name:

  2. Email Contact:

  3. Location (City/State, Sovereign Nation, or Territory): 

  4. What is your ethnicity? Please select one.

Options: Not Hispanics/Latino/a/x/e; Hispanics/Latino/a/x/e; Decline to state; Write in (insert text box)

  1. What is your race? Please select all that applies.

Options: Asian/Asian American; Black/African American; Indigenous American/Native Alaskan; Middle Eastern/Arab American; More than one race; Pacific Islanders/Native Hawaiian; White; Decline to state; Write in (insert text box).


Begin Survey Questions:


  1. As a result of your participation in the Lab have you modified the way you collaborate with communities and facilitate training/workshops? (Yes/No). 

If yes: Please share an example.

  1. Have you used the resources shared from the Racial Equity Learning Lab webinar? (Yes/No). 

A. If yes: Please share how you have used the resources.

B. If you answered “no” to the questions above: Please tell us how we can make the resources more available and useful for you.

  1. Are you interested in scheduling a brief call with NFSN to discuss your efforts around embedding racial equity in farm to school? (Yes/No).

  2. What other feedback do you have to share?



File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorDuncan-Hughes, Dionne - FNS
File Modified0000-00-00
File Created2023-12-12

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