State, Local and Tribal Agencies

SNAP-Ed Toolkit Submission Form and Scoring Tool (FNS 885 and FNS 886) w/ Screenshots

Documents and Forms

Document Name Document Type
Appendix 1 - FNS 885 SNAP-Ed Toolkit Scoring Tool Qualtrics Screenshot Version_01Oct2021.docx snapedtoolkit.org/interventions/submit-an-intervention. Other-Appendix 1 FNS 885 Screenshot
Appendix 2 - FNS 886 SNAP-Ed Toolkit Intervention Submission Form Qualtrics Screenshot Version_01Oct2021.docx snapedtoolkit.org/interventions/submit-an-intervention. Other-Appendix 2 - FNS 886 SNAP-Ed T
Appendix C1. FNS-886 Intervention Submission Form Online Survey Screenshot.pdf Other-FNS 886 Screenshot
FNS 885 SNAP-ED TOOLKIT INTERVENTION SCORING TOOL Appendix 1.1 FNS 885 Final Draft 10-6-2021.rtf Form and Instruction
FNS 886 SNAP-ED TOOLKIT INTERVENTION SCORING TOOL Appendix 2.1 FNS 886 Final Draft 10-6-2021.rtf snapedtoolkit.org/interventions/submit-an-intervention. Form and Instruction
FNS 886 SNAP Ed Intervention Submission Form FNS-886 Intervention Submission Form 11.25.24.pdf Form and Instruction
FNS 885 SNAP Ed Toolkit Intervention Scoring Tool FNS-885 Intervention Scoring Tool 11.25.24.xlsx Form and Instruction

Information Collection (IC) Details

IC Title:	State, Local and Tribal Agencies	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 7 CFR § 272.2(2)(d) (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	FNS 886	SNAP Ed Intervention Submission Form	FNS-886 Intervention Submission Form 11.25.24.pdf	Yes	Yes	Fillable Printable
Form and Instruction	FNS 885	SNAP Ed Toolkit Intervention Scoring Tool	FNS-885 Intervention Scoring Tool 11.25.24.xlsx	Yes	Yes	Fillable Printable
Other-FNS 886 Screenshot			Appendix C1. FNS-886 Intervention Submission Form Online Survey Screenshot.pdf	Yes	Yes	Fillable Printable

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records
Title: FNS-8 USDA/FNS Studies and Reports	FR Citation: 56 FR 19078

Number of Respondents: 37	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	67	14	53
Annual IC Time Burden (Hours)	234	98	136
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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