OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

State and Local Burden - SA, SFA/LEA

IC 2879 under ICR 202404-0584-006 · OMB 0584-0006.

Documents and Forms

Documents and forms in this information collection
Document NameDocument 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)

layout table

Information Collection Instruments:
table that charts list of instruments
Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted 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


table that charts list of burden
  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 48,035,516 0 403,520 0 0 47,631,996
Annual IC Time Burden (Hours) 10,143,277 0 334,576 0 0 9,808,701
Annual IC Cost Burden (Dollars) 21,819,000 0 21,819,000 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.