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
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

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Appendix 1 FNS 885 Screenshot			Appendix 1 - FNS 885 SNAP-Ed Toolkit Scoring Tool Qualtrics Screenshot Version_01Oct2021.docx	https://snapedtoolkit.org/interventions/submit-an-intervention.	Yes	Yes	Fillable Fileable Signable
Form and Instruction	FNS 885	SNAP-ED TOOLKIT INTERVENTION SCORING TOOL	Appendix 1.1 FNS 885 Final Draft 10-6-2021.rtf		Yes	No	Fillable Printable
Other-Appendix 2 - FNS 886 SNAP-Ed Toolkit Intervention Submission Form Qualtrics Screenshot			Appendix 2 - FNS 886 SNAP-Ed Toolkit Intervention Submission Form Qualtrics Screenshot Version_01Oct2021.docx	https://snapedtoolkit.org/interventions/submit-an-intervention.	Yes	Yes	Fillable Fileable Signable
Form and Instruction	FNS 886	SNAP-ED TOOLKIT INTERVENTION SCORING TOOL	Appendix 2.1 FNS 886 Final Draft 10-6-2021.rtf	https://snapedtoolkit.org/interventions/submit-an-intervention.	Yes	Yes	Fillable Fileable Signable

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 %

	Requested	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.