Information Collection

SNMCS State, Local & Tribal Governments

IC 211122 under ICR 201404-0584-003 · OMB 0584-0596.

Documents and Forms

Document Name Document Type
D1. Group 2—SFA Director Planning Interview.docx Other-D1. Group 2—SFA Director Plann
D2. Group 3—Foodservice Manager Pre-Visit Telephone Interview Questionnaire.docx Other-D2. Group 3—Foodservice Manage
D3. Group 3—School Principal Cost Interview Guide.doc Other-D3. Group 3—School Principal C
D4. Group 3—State Education Agency Finance Officer Indirect Cost Survey.docx Other-D4. Group 3—State Education Ag
D5. Group 3—SFA Follow-Up Cost Interview Preparation Form.doc Other-D5. Group 3—SFA Follow-Up Cost
D6. Group 3—SFA DirectorLEA Business Manager Foodservice Expense Statement Follow-Up.docx Other-D6. Group 3—SFA DirectorLEA Bu
D7. Group 3—SFA DirectorLEA Business Manager Foodservice Revenue Statement.docx Other-D7. Group 3—SFA DirectorLEA Bu
D8. Group 3—SFA DirectorLEA Business Manager SFA Indirect Cost Questionnaire – Follow-Up.docx Other-D8. Group 3—SFA DirectorLEA Bu
E1. Group 3—SFA Director Cost Interview Preparation Forms.doc Other-E1. Group 3—SFA Director Cost
E2. Group 3—SFA DirectorLEA Business Manager SFA Staffing and Operations Interview.docx Other-E2. Group 3—SFA DirectorLEA Bu
E3. Group 3—SFA DirectorLEA Business Manager SFA Indirect Cost Questionnaire—On-Site.docx Other-E3. Group 3—SFA DirectorLEA Bu
E4. Group 3—SFA DirectorLEA Business Manager Off-Budget District Staff Interview Guide revised 2014.05.23.doc Other-E4. Group 3—SFA DirectorLEA Bu
E5. Group 3—SFA DirectorLEA Business Manager Preliminary Foodservice Expense Statement revised 2014.05.23.docx Other-E5. Group 3—SFA DirectorLEA Bu
E6. Group 3—Foodservice Manager Cost Interview.docx Other-E6. Group 3—Foodservice Manage
E7. Group 3—SFA Food Cost Worksheet and Instructions.docx Other-E7. Group 3—SFA Food Cost Work
F1. Groups 1, 2, 3—SFA Director Survey.docx Other-F1. Groups 1, 2, 3—SFA Directo
F2. Groups 2, 3—FSM Survey.docx Other-F2. Groups 2, 3—FSM Survey
F3. Groups 2, 3—Principal Survey.docx Other-F3. Groups 2, 3—Principal Surv
H1. GROUP 2—BASIC MENU SURVEY.pdf Other-H1. GROUP 2—BASIC MENU SURVEY
H2. GROUP 2—EXPANDED MENU SURVEY.pdf Other-H2. GROUP 2—EXPANDED MENU SURV
H3. Group 2, 3—FSM A la Carte Foods Checklist (Basic and Expanded Menu Survey).docx Other-H3. Group 2, 3—FSM A la Carte
H4. Group 2, 3—FSM A la Carte Foods Checklist Instructions _Basic and Expanded Menu Survey_.pdf Other-H4. Group 2, 3—FSM A la Carte
I. Group 2—FSM Request for Data on Reimbursable Meal Sales.docx Other-I. Group 2—FSM Request for Dat
J. Groups 2, 3—Competitive Foods Training Module.pptx Other-J. Groups 2, 3—Competitive Foo
K1. Groups 2, 3—School Staff Liaison Vending Machine Form-Simple.docx Other-K1. Groups 2, 3—School Staff L
K2. Groups 2, 3—School Staff Liaison Vending Machine Form-Enhanced.docx Other-K2. Groups 2, 3—School Staff L
K3. Groups 2, 3—School Staff Liaison Other Sources Checklist revised 2014.05.23.docx Other-K3. Groups 2, 3—School Staff L
P1. Cafeteria Observation Guide (Interviewer-Completed).docx Other-P1. Cafeteria Observation Guid
P2. Group 2—Point of Sale Form (Interviewer-Completed).docx Other-P2. Group 2—Point of Sale Form
P4. Group 3—Plate Waste Observation Booklet (Interviewer-Completed).docx Other-P4. Group 3—Plate Waste Observ
C1 School Nutrition Association Endorsement Letter revised 2014.05.23.pdf C1. School Nutrition Association Endorsement Letter IC Document
C2. Groups 1, 2, 3—State Child Nutrition Director Study Introduction Email revised 2014.05.23.docx C2. Groups 1, 2, 3—State Child Nutrition Director Study Introduction Email IC Document
C3. Group 2—SFA Director Recruitment Advance Letter.docx C3. Group 2—SFA Director Recruitment Advance Letter IC Document
C4. Group 2—SFA Director Recruitment Confirmation Letter 2014.04.01.docx C4. Group 2—SFA Director Recruitment Confirmation Letter 2014.04.01 IC Document
C5. Group 3—SFA Director Recruitment Advance Letter 2014.04.01.docx C5. Group 3—SFA Director Recruitment Advance Letter 2014.04.01 IC Document
C6. Group 3—SFA Director Recruitment Confirmation Letter 2014.04.01.docx C6. Group 3—SFA Director Recruitment Confirmation Letter 2014.04.01 IC Document
C7. Group 3—SFA Director Pre-Visit Advance Letter 2014.04.01.docx C7. Group 3—SFA Director Pre-Visit Advance Letter 2014.04.01 IC Document
C8. Group 2—Foodservice Manager Introduction Letter.docx C8. Group 2—Foodservice Manager Introduction Letter IC Document
C9. Group 3—Foodservice Manager Introduction Letter.docx C9. Group 3—Foodservice Manager Introduction Letter IC Document
C10. Group 2—Principal Introduction Letter to Schools.docx C10. Group 2—Principal Introduction Letter to Schools IC Document
C11. Group 3—Principal Introduction Letter to Schools.docx C11. Group 3—Principal Introduction Letter to Schools IC Document
C12. Group 3—Principal Pre-Visit Advance Letter.docx C12. Group 3—Principal Pre-Visit Advance Letter IC Document
C13. Group 2—Recruiting Call Script rev 2014.05.22.docx C13. Group 2—Recruiting Call Script 2014.04.01 IC Document
C14. Group 3—Recruiting Call Script 2014.04.01.docx C14. Group 3—Recruiting Call Script 2014.04.01 IC Document
C15. Group 2—Study Overview.docx C15. Group 2—Study Overview IC Document
C16. Group 3—Study Overview.docx C16. Group 2—Study Overview IC Document
G1. Groups 1, 2, 3—SFA Director E-mail Invitation .docx G1. Groups 1, 2, 3—SFA Director E-mail Invitation IC Document
G2. Groups 2, 3—Principal E-mail Invitation.docx G2. Groups 2, 3—Principal E-mail Invitation IC Document
P3. Group 2—Milk Form (Interviewer-Completed).docx P3. Group 2—Milk Form IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	SNMCS State, Local & Tribal Governments	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-D1. Group 2âSFA Director Planning Interview	D1. Group 2âSFA Director Planning Interview.docx	No		Paper Only
Other-D2. Group 3âFoodservice Manager Pre-Visit Telephone Interview Questionnaire	D2. Group 3âFoodservice Manager Pre-Visit Telephone Interview Questionnaire.docx	No		Paper Only
Other-D3. Group 3âSchool Principal Cost Interview Guide	D3. Group 3âSchool Principal Cost Interview Guide.doc	No		Paper Only
Other-D4. Group 3âState Education Agency Finance Officer Indirect Cost Survey	D4. Group 3âState Education Agency Finance Officer Indirect Cost Survey.docx	No		Paper Only
Other-D5. Group 3âSFA Follow-Up Cost Interview Preparation Form	D5. Group 3âSFA Follow-Up Cost Interview Preparation Form.doc	No		Paper Only
Other-D6. Group 3âSFA DirectorLEA Business Manager Foodservice Expense Statement Follow-Up	D6. Group 3âSFA DirectorLEA Business Manager Foodservice Expense Statement Follow-Up.docx	No		Paper Only
Other-D7. Group 3âSFA DirectorLEA Business Manager Foodservice Revenue Statement	D7. Group 3âSFA DirectorLEA Business Manager Foodservice Revenue Statement.docx	No		Paper Only
Other-D8. Group 3âSFA DirectorLEA Business Manager SFA Indirect Cost Questionnaire â Follow-Up	D8. Group 3âSFA DirectorLEA Business Manager SFA Indirect Cost Questionnaire â Follow-Up.docx	No		Paper Only
Other-E1. Group 3âSFA Director Cost Interview Preparation Forms	E1. Group 3âSFA Director Cost Interview Preparation Forms.doc	No		Paper Only
Other-E2. Group 3âSFA DirectorLEA Business Manager SFA Staffing and Operations Interview	E2. Group 3âSFA DirectorLEA Business Manager SFA Staffing and Operations Interview.docx	No		Paper Only
Other-E3. Group 3âSFA DirectorLEA Business Manager SFA Indirect Cost QuestionnaireâOn-Site	E3. Group 3âSFA DirectorLEA Business Manager SFA Indirect Cost QuestionnaireâOn-Site.docx	No		Paper Only
Other-E4. Group 3âSFA DirectorLEA Business Manager Off-Budget District Staff Interview Guide	E4. Group 3âSFA DirectorLEA Business Manager Off-Budget District Staff Interview Guide revised 2014.05.23.doc	No		Paper Only
Other-E5. Group 3âSFA DirectorLEA Business Manager Preliminary Foodservice Expense Statement	E5. Group 3âSFA DirectorLEA Business Manager Preliminary Foodservice Expense Statement revised 2014.05.23.docx	No		Paper Only
Other-E6. Group 3âFoodservice Manager Cost Interview	E6. Group 3âFoodservice Manager Cost Interview.docx	No		Paper Only
Other-E7. Group 3âSFA Food Cost Worksheet and Instructions	E7. Group 3âSFA Food Cost Worksheet and Instructions.docx	No		Paper Only
Other-F1. Groups 1, 2, 3âSFA Director Survey	F1. Groups 1, 2, 3âSFA Director Survey.docx	Yes	Yes	Fillable Fileable
Other-F2. Groups 2, 3âFSM Survey	F2. Groups 2, 3âFSM Survey.docx	Yes	Yes	Fillable Fileable
Other-F3. Groups 2, 3âPrincipal Survey	F3. Groups 2, 3âPrincipal Survey.docx	Yes	Yes	Fillable Fileable
Other-H1. GROUP 2âBASIC MENU SURVEY	H1. GROUP 2âBASIC MENU SURVEY.pdf	Yes	Yes	Fillable Fileable
Other-H2. GROUP 2âEXPANDED MENU SURVEY	H2. GROUP 2âEXPANDED MENU SURVEY.pdf	Yes	Yes	Fillable Fileable
Other-H3. Group 2, 3âFSM A la Carte Foods Checklist _Basic and Expanded Menu Survey	H3. Group 2, 3âFSM A la Carte Foods Checklist (Basic and Expanded Menu Survey).docx	Yes	Yes	Fillable Fileable
Other-H4. Group 2, 3âFSM A la Carte Foods Checklist Instructions _Basic and Expanded Menu Survey	H4. Group 2, 3âFSM A la Carte Foods Checklist Instructions _Basic and Expanded Menu Survey_.pdf	Yes	Yes	Fillable Fileable
Other-I. Group 2âFSM Request for Data on Reimbursable Meal Sales	I. Group 2âFSM Request for Data on Reimbursable Meal Sales.docx	No		Paper Only
Other-J. Groups 2, 3âCompetitive Foods Training Module	J. Groups 2, 3âCompetitive Foods Training Module.pptx	No		Paper Only
Other-K1. Groups 2, 3âSchool Staff Liaison Vending Machine Form-Simple	K1. Groups 2, 3âSchool Staff Liaison Vending Machine Form-Simple.docx	No		Paper Only
Other-K2. Groups 2, 3âSchool Staff Liaison Vending Machine Form-Enhanced	K2. Groups 2, 3âSchool Staff Liaison Vending Machine Form-Enhanced.docx	No		Paper Only
Other-K3. Groups 2, 3âSchool Staff Liaison Other Sources Checklist	K3. Groups 2, 3âSchool Staff Liaison Other Sources Checklist revised 2014.05.23.docx	No		Paper Only
Other-P1. Cafeteria Observation Guide	P1. Cafeteria Observation Guide (Interviewer-Completed).docx	No		Paper Only
Other-P2. Group 2âPoint of Sale Form	P2. Group 2âPoint of Sale Form (Interviewer-Completed).docx	No		Paper Only
Other-P4. Group 3âPlate Waste Observation Booklet	P4. Group 3âPlate Waste Observation Booklet (Interviewer-Completed).docx	No		Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

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

Number of Respondents: 16,521	Number of Respondents for Small Entity: 200

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 20 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	16,521	16,521
Annual IC Time Burden (Hours)	17,957	17,957
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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