Form FNS 759 FNS 759 Food Stamp Nutrition Education EARS Reporting Form

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Form Approved OMB No. 0584-0542
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Supplemental Nutrition Assistance Program Education (SNAP-Ed)
EARS Reporting Form
OMB BURDEN STATEMENT: 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 0584-0542. The time to complete this information collection is estimated to average
54 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the
data needed, and completing and reviewing the collection of information. OMB #0584-0542 expires 08/31/2010.

State:

Federal Fiscal Year:

Number of Implementing Agencies*:
Name of Each Implementing Agency*

* An implementing agency is defined as an organization that has a contract/formal agreement with the
State Supplemental Nutrition Assistance Program (SNAP) to develop and deliver nutrition education
activities in the state. Attach additional pages if necessary.
DIRECT EDUCATION:
Items #1-6 ask for information about participants and activities associated with direct SNAP Education
(SNAP-Ed). Direct Education is defined as interventions where a participant is actively engaged in the
learning process with an educator and/or interactive media. Direct education provides an opportunity to
obtain information about individual participants. For an activity to qualify as direct education, information
on the number of individuals, SNAP participation status, age, gender, and race/ethnicity must be collected.
Example 1: An implementing agency conducts a series of nutrition sessions designed to increase fruit and
vegetable intake. The educators collect enrollment data including name, age, race, ethnic group, SNAP
participation and gender.
Example 2: The implementing agency provides nutrition education via kiosks at several locations.
Participant using the kiosks provides identifying information including their SNAP status, ethnicity, age and
gender by entering this data or by using codes that can be linked to this information by the implementing
agency.
Situations that would not count as “direct education” include cases where an individual obtains nutrition
education or materials or listens to a session but no demographic information is captured about the
individual. This would count as indirect education.

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Direct Education: SNAP-Ed Participants and Contacts
1a. Direct Education: SNAP-Ed PARTICIPANTS by Age and SNAP Status - Reporting an unduplicated
count of direct education participants means providing the number of different individuals who receive any
SNAP-Ed direct education. Each individual counts as one participant, regardless of the number of times
he or she has participated in direct education activities. You are encouraged to provide actual
unduplicated counts but if you are unable, you should estimate the number of individuals served.

•

For Question 1a, indicate below if you are providing actual unduplicated counts or an estimate of
SNAP-Ed direct education participants.
Actual Counts of Participants (unduplicated)
Estimated Counts of Participants
A
Less
than 5
Years
1
2
3

Number of SNAP
Recipients in SNAP-Ed
Number of All Other
Participants in SNAP-Ed
Total Number of SNAPEd Participants

B
5-17
Years

C
18-59
Years

D
60 Years
or More

E
All Ages
Combined

Grades K-12

If you reported an estimate in Question 1a, please describe in 100 words or less the methods used to
estimate the number of participants.

1b. Direct Education: SNAP-Ed CONTACTS by Age and SNAP Status
A “SNAP-Ed contact” is defined as an interaction in which a SNAP-Ed participant participates in a direct
education activity. Each SNAP-Ed participant may have one or more SNAP-Ed contacts.

•

For Question 1b, indicate below if you are providing actual counts or an estimate of SNAP-Ed direct
education contacts.
Actual Counts of Contacts
Estimated Counts of Contacts

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A
Less
than 5
Years
1
2
3

Contacts with SNAP
Recipients in SNAP-Ed
Contacts with All Other
Persons in SNAP-Ed
Total Contacts of SNAPEd Participants

B
5-17
Years

C
18-59
Years

D
60 Years
or More

E
All Ages
Combined

Grades K-12

If you reported an estimate in Question 1b, please describe in 100 words or less the methods used to
estimate the number of contacts.

Instructions for Question 1a and 1b
• Row 1: Enter the total number of participants (1a) and contacts (1b) who are SNAP recipients by
each age range and for all ages combined (Row 1; Columns A-E).
• Row 2: Enter the total participants (1a) and contacts (1b) for all other (non- SNAP) persons by
each age range and for all ages combined (Row 2; Columns A-E). This includes persons who are
eligible non-participants with respect to the SNAP combined with persons who are not eligible for the
SNAP.
• Row 3: Enter the total participants (1a) and contacts (1b) for SNAP-Ed by age category (Row 3;
Columns A-E). Each number in Row 3 should equal the sum of Rows 1 and 2 in that column.

Special Circumstances
○ If necessary, determine SNAP status among children (columns A and B) who receive SNAP-Ed
services in school and child care settings by multiplying the number of children participating in SNAP-Ed
at each school or child care facility by the percent of students enrolled in the FREE school lunch program.
Example: An elementary school program has 100 children participating in SNAP-Ed and the school's free
lunch participation rate is 60%. In the “5-17 Years (grade K-12)” column, report 60 students under
“Number of SNAP Participants in SNAP-Ed” and 40 students under “Number of All Other Participants in
SNAP-Ed” for a total of 100 students.
○ Teen-age SNAP-Ed participants should be counted by their age for Question 1 even if they are
parents.
Example: If the teen parent is 16 years old, they should be counted under Column B, 5-17 Years (Grades
K-12). If the teen is 19 years old, they should be counted under Column C 18-59 Years.

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2a. Direct Education: SNAP-Ed PARTICIPANTS by Gender

•

For Question 2a, indicate below if you are providing an unduplicated count or an estimate of
SNAP-Ed direct education participants.
Actual Counts of Participants (unduplicated)
Estimated Counts of Participants
A
Female
1

B
Male

Number of SNAP-Ed Participants

If you reported an estimate in Question 2a, please describe in 25 words or less the methods used to
estimate the number of participants.

2b. Direct Education: SNAP-Ed CONTACTS by Gender

•

For Question 2b, indicate below if you are providing actual counts or an estimate of SNAP-Ed direct
education contacts.
Actual Counts of Contacts
Estimated Counts of Contacts
A
Female
1

B
Male

Number of SNAP-Ed Contacts

If you reported an estimate in Question 2b, please describe in 25 words or less the methods
used to estimate the number of contacts.

Instructions for Question 2a and b
Enter the DIRECT EDUCATION participants (2a) and contacts (2b) by gender in Row 1; Columns A and
B of Table 2a and 2b. The total of A and B in Table 2a should equal the total number of SNAP-Ed
participants in Question 1a, Row 3, Column E. The total of A and B in Table 2b should equal the total
number of SNAP-Ed contacts in Question 1b, Row 3, Column E.

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3. Direct Education: Race and Ethnicity

•

For Question 3, indicate below if you are providing actual unduplicated counts or an estimate of
SNAP-Ed direct education participants.
Actual Counts of Participants (unduplicated)
Estimated Counts of Participants
A

B

Number of
Number of
Hispanic or Latino Non-Hispanic/Latino
SNAP-Ed
SNAP-Ed
Participants by Race Participants by Race
Individuals
Reporting
ONLY ONE
RACE

C
Total by Race

1. American Indian or Alaska
Native
2. Asian
3. Black or African American
4. Native Hawaiian or Other
Pacific Islander
5. White

Individuals
Reporting
MULTIPLE
RACES

6. American Indian or Alaska
Native and White
7. Asian and White
8. Black or African American
and White
9. American Indian or Alaska
Native and Black
or African American
10. All Others Reporting More
than One Race
11. TOTAL by ethnicity

Instructions for Question 3
• For purposes of this form, “Hispanic or Latino” is an ethnic group, not a race.
• Column A: Report the number of Hispanic or Latino SNAP-Ed participants for each racial category listed
in Rows1-11. Specifically, in Rows 1-5, report the number of SNAP-Ed participants who are of Hispanic
or Latino ethnicity and report only one race. In Rows 6-10, report the number of SNAP-Ed participants
who are of Hispanic or Latino ethnicity and report two or more races. Use Row 10 for all SNAP-Ed
participants who are of Hispanic or Latino ethnicity and describe themselves with a racial combination
not included in Rows 6-9. For Row 11, enter the sum of Rows 1-10 under Column A.
• Column B: Report the number of SNAP-Ed participants who are not of Hispanic or Latino ethnicity for
each racial category listed in Rows 1-10. Specifically, in Rows 1-5, report the number of SNAP-Ed
participants who are not of Hispanic or Latino ethnicity and report only one race. In Rows 6-10, report
the number of SNAP-Ed participants who are not of Hispanic or Latino ethnicity and report two or more
races. Use Row 10 for all SNAP-Ed participants who are not Hispanic or Latino ethnicity and describe
themselves with a racial combination not included in Rows 6-9. In Row 11, enter the sum of Rows 1-10
under Column B.
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• Column C: Add the number of SNAP-Ed participants reported in Column A and Column B for each row.
For Column C, Row 11, add the numbers reported in Column C.
Example 1: A SNAP-Ed participant who reports they are Hispanic and Black is counted in Column A, Row 3.
Example 2: A SNAP-Ed participant who reports being White, Asian, and Black but not Hispanic is counted
in Column B, Row 10.
4. Direct Education: Number of SNAP-Ed Delivery Sites by Type of Setting
Type of Setting

Number of
Different
Sites/
Locations

Type of Setting

Adult Education & Job Training
Sites

Libraries

Adult Rehabilitation Centers

Churches

Worksites

Public/Community Health Centers

Community Centers

Public Schools

Elderly Service Centers

Head Start Programs

Emergency Food Assistance Sites

Other Youth Education Sites
(includes Parks and Recreation)

Extension Offices

Shelters

Farmers Markets

WIC Programs

SNAP Offices

Other (please specify):

Food Stores

Other (please specify):

Public Housing

Other (please specify):

Individual Homes

Other (please specify):

Number of
Different
Sites/
Locations

Instructions for Question 4
For each type of DIRECT EDUCATION setting used, enter the number of different sites/
locations used within the State. Record each site only ONCE on this form.

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Example 1: SNAP-Ed is provided to residents of a shelter that is located in a local church. Record this site
under “Church”.
Example 2: SNAP-Ed is provided to participants in Head Start which is operating in the local elementary
school which also has SNAP-Ed activities with the elementary school students. Record this site only once
under “Public School”.
• If you provide interactive multimedia education, please report locations where kiosks/computers
are available.
Example 3: SNAP-Ed is provided through interactive multimedia via kiosks in 15 food stores and 10
worksites that have no other SNAP-Ed activities. These kiosks should be added to the numbers of sites
reported under the food stores and worksite categories in Question 4.
5. Direct Education Programming Format

Format

1

Single session

2

Series - 2 to 4 sessions

3

Series - 5 to 9 sessions

4

Series - 10 or more sessions

A
Number delivered

B

C

Time range per
session
(in minutes)

% delivered by
interactive
multimedia

Instructions for Question 5

•
•
•

For Rows 1-4, Column A, enter the number of single sessions, the number of 2-4 session series, the
number of 5-9 session series, and the number of series with 10 or more sessions delivered.
For Rows 1-4, Column B, enter the time range per session in minutes.
For Rows 1-4, Column C, enter the percent of Column A delivered by interactive multimedia lessons/
modules.
Example 1: A state reports that 40 single sessions were delivered ranging in time from 45-60 minutes
and that 10% were delivered by interactive multimedia. Row 1 of the form would show:

1

Format

A
Number delivered

B
Time range per
session
(in minutes)

C
% delivered by
interactive
multimedia

Single session

40

45-60 minutes

10%

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6.Primary Content of Direct Education
CODE:

CODE:

CODE:

CODE:

INSTRUCTIONS for Question 6
• Identify up to four educational topic areas of emphasis from the list below. These four topic areas
should reflect those areas given most emphasis (e.g. taught most frequently) in your State. Record
only one code per box. DO NOT REPORT SNAP OUTREACH IN THIS TABLE.
A. FAT FREE & LOW FAT MILK OR EQUIV (& ALTERNATE CALCIUM SOURCES)
B. FATS AND OILS
C. FIBER-RICH FOODS
D. FOOD SHOPPING/PREPARATION
E. FRUITS & VEGETABLES
F. LEAN MEAT AND BEANS
G. LIMIT ADDED SUGARS OR CALORIC SWEETNERS
H. MYPYRAMID - HEALTHY EATING PLAN
I. PHYSICAL ACTIVITY
J. PROMOTE HEALTHY WEIGHT
K. SODIUM & POTASSIUM
L. WHOLE GRAINS
M. FOOD SAFETY
(possible for electronic form)
N. OTHER (specify):
O. OTHER (specify):
P. OTHER (specify):
Q. OTHER (specify):

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SOCIAL MARKETING INITIATIVES:
Item #7 asks for information about SNAP-Ed social marketing initiatives. Social Marketing is defined as a consumer-focused, research-based
process to plan, implement and evaluate interventions that are designed to influence the voluntary behavior of a large number of people in the
target audience (adapted from Alan Andreasen 1995 and Social Marketing Division of Society for Nutrition Education).
For an activity to qualify as a social marketing campaign, the initiative being reported must have included all of the following steps:
• Identified a specific segment of the SNAP/low income population to target
• Identified the specific nutrition needs of the target audience, associated target behavior(s), and the target audience's reasons for
and against changing behavior.
• Interacted with the target audience to see if the message, materials, and delivery channel are understood and meaningful (would
lead to behavior change).
States that conduct social marketing campaigns that include both direct and indirect education activities may elect to report these under these
categories. However, if direct and indirect education activities are reported in the “direct education” section or the “indirect education” section, they
should not be reported in the social marketing section because that would result in a duplicate count.
7. Description of ALL Social Marketing Campaigns
Attach an additional form to record data, if there are more than five campaigns.
A. Name of Campaign

B.
Current
Year of
Campaign

C.
Major
Campaign
Activities for
Current Year

D.
Priority Population(s)
Use Codes

Use Codes

E.
Estimated
Number. of
SNAP
Recipients
Reached

F.
Estimated
Number of
Other Low
Income
Persons
Reached

G.
Total Estimated
Reach
(Low Income,
SNAP Recipients
AND
All Others)

1
2
3
4
5
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Instructions for Question 7
For each social marketing campaign being planned, under development or operating:

•
•

Column A: Enter the name of all FNS approved social marketing campaigns.

•

Column C: Enter one or more of the following codes that describe major phases of campaign activities:

Column B:. Enter the current campaign year for this annual reporting cycle. Be sure to include planning and development phases.
Example: If this is the third year of a five year campaign, record 3 in Column B.

o P=Planning (includes market and formative research),
o D=Developing (includes campaign/materials design and consumer testing),
o I=Implementing
o E=Tracking and Evaluation

•

Column D: Enter all of the appropriate codes describing the priority population (target audience) that this campaign reached during this fiscal
year:
○ Ethnicity:

F=Hispanic or Latino
G=Not-Hispanic or Latino

○ Race:

A=American Indian or Native Alaska
B=Asian
C=Black or African American
D=Native Hawaiian or Other Pacific Islander
E=White

○ Gender:

H=Female
I=Male

○ Age:

J=All ages
K=Less than 5 years of age
L=5 to 17 years of age
M=18 to 59 years of age
N=60 years of age or older

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For Columns E, F and G, enter the number of people reached, as estimated from demographic or marketing data or other sources.

•
•
•

Column E: Enter the estimated number of SNAP recipients reached this reporting year through this campaign
Column F: Enter the estimated number of low-income persons (EXCLUDING SNAP recipients) reached through this campaign this reporting year.
Column G: Enter the total estimated number of people (low-income, SNAP recipients AND all others) reached this reporting year.

Example 1: The radio station that broadcasts social marketing nutrition messages has provided demographic statistics to the implementing partner
showing the income range of their listening audience. The data show that roughly 20% of the audience or 400 people would not qualify for SNAP
benefits. The estimated count of 400 people should be counted under column G in Item 7 of the form.
Example 2: Nutrition education is conducted at a local grocery store in a low-income neighborhood and 200 people attend. Census track data is
examined and shows that 55% of the population served by the store has income below 130% of the poverty level and 30% has income between
130% and 185% of the poverty level with the remaining 15% having income over 185% of the poverty level. In Column E, 110 (55% of 200
participants) should be included, 60 should be included in Column F (30% of 200) and 200 should be reported in Column G.
7. Continued-Description of ALL Social Marketing Campaigns
H.
Primary Intervention
Levels

I.
Key Messages

J.
Primary Intervention Channels

Use Codes

Use Codes

Use Codes

K.
Total Expenditure
for Social Marketing
Campaign for
Reporting Year

1

$

2

$

3

$

4

$

5

$

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L.
Total Federal
SNAP-Ed
Expenditure for
Reporting Year

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Instructions for Question 7

•

Column H: Enter one or more codes describing each campaign's level(s) of intervention:
○
○
○
○
○
○

•
•

Column I: Enter up to three codes for each campaign's priority education topics/messages. Use the codes listed in the Instructions for Item # 6.
Column J: Enter all of the codes corresponding to the intervention channels used in each campaign:
○
○
○
○
○
○
○
○
○
○
○
○
○
○
○

•
•

A=Individual
B=Interpersonal (groups)
C=Institution/Organization
D=Community
E=All Levels
F=Other – please specify

A=Nutrition Education Radio Public Service Announcement (PSA)
B=Nutrition Education TV Public Service Announcement (PSA)
C=Nutrition Education articles
D=Billboards, bus wraps, or other signage
E=Participation in community events/fairs
F=Sponsor community events/fairs
G=Fact sheets/pamphlets/newsletters
H=Posters
I=Calendars
J=Promotional materials w/nutrition messages (pens, pencils, wallet reference cards, magnets, cups, etc)
K=Website
L=Electronic (email) materials/info distribution
M=Videos/CD-Rom
N=Retail/point-of-purchase activities
O=Other – please specify

Column K: Enter the total expenditure (include all State and Federal SNAP-Ed and any other sources of funds) for the campaign this
reporting year.
Column L: Enter the Federal SNAP-Ed expenditures for the campaign this reporting year.

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INDIRECT EDUCATION:
Item #8 asks for information about SNAP indirect education. Indirect Education is defined as the
distribution of information and resources, including any mass communications, public events and
materials distribution that DO NOT meet the definitions of Direct Education or Social Marketing
Campaigns. Mass communication, public events and material distribution efforts that don't meet the
definition of social marketing should be reported here.
8a. Types of Materials Distributed
Check if applicable

Fact sheets/ pamphlets/newsletters
Posters
Calendars
Promotional Materials w/nutrition messages (pens/
pencils/wallet reference cards/magnets/cups/etc)
Website
Electronic (Email) materials/info distribution
Videos/CD Rom
Other
Instructions for Question 8a
Check all methods/materials used for indirect education.
8b.

Estimated Size of Audiences Reached through Communication and Events
Estimated No. of target
population reached

Source of Data

Nutrition Education Radio PSAs
Nutrition Education TV PSAs
Nutrition Education Articles
Billboard, Bus or Van Wraps, or Other Signage
Community Events/Fairs -- in which Participated
Community Events/Fairs -- Only Sponsored
Other

Instructions for Question 8b
For each type of communication channel and event enter the estimated number of individuals in the
target population(s) reached and the code of the source of the data used to tabulate the estimate.
1 = commercial market data on audience size
2 = survey of target audience
3 = visual estimate
4= other

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9.Expenditures by Sources of Funding (See Instructions)
Expenditures for
Reporting Year
l. Public Cash Contributions -- State and Local Tax Revenue only
2. Public and Private Cash Contributions -- other than State and Local
Tax Revenue

$

3. Sum of Lines 1 & 2

$

4. Public In-Kind Contributions (non-cash)

$

5. Private Cash Contributions to State SNAP Agency only

$

6. Indian Tribal Organization Contributions

$

$

7. Sum of Lines 4, 5 & 6

$

8. Federal Reimbursement

$

9. TOTAL SNAP-Ed EXPENDITURES: Sum of Lines 3, 7 & 8

$

Instructions for Question 9
All dollar amounts recorded in item #9 should reflect actual expenditures NOT those initially budgeted.
• Line1: Enter the dollar value of expenditures paid only with State and local tax revenue
designated specifically for SNAP-Ed activities.
• Line 2: Enter the dollar value of expenditures paid with public and private cash contributions.
These are contributions that are received by state implementing agencies or their subcontractors
other than State and local tax revenues designated specifically for SNAP-Ed activities. These
are not from State and local tax revenues.
• Line 3: Enter the sum of lines 1 and 2 in line 3.
• Line 4: Enter the dollar value of expenditures paid with public in-kind (non-cash) contributions.
These contributions are defined as goods or services provided by a state or local agency for
which no cash funds are transferred and no out-of-pocket cost is incurred by the contributing
agency. Typically, in-kind contributions are the value of goods or services provided by
volunteers.
• Line 5: Enter the dollar value of expenditures paid with private cash contributions made to the
State SNAP Office/Agency These contributions are funds provided by non-governmental groups.
They may include cash provided to the State or outlays made directly by a non-governmental
organization to cover approved SNAP-Ed costs.
• Line 6: If applicable, enter the dollar value of expenditures paid with Indian Tribal Organization
(ITO) contributions. Although technically ITO contributions are Federal funds, for the purposes
of SNAP-Ed reimbursement, they are considered state match.
• Line 7: Enter the sum of lines 4, 5 and 6 in line 7. This may be less than 50% of the Total
SNAP-Ed Expenditures in line 9 when there is an ITO contribution because FNS reimburses
allowable activities conducted on Indian reservations at the 75% rate.
• Line 8: Enter the total amount of the federal reimbursement for SNAP-Ed; this is the total
amount chargeable to FNS. It may be greater than 50% of total outlays when there is an ITO
contribution because FNS reimburses for allowable activities conducted on Indian reservations
at the 75% rate.
• Line 9: Enter the sum of lines 3, 7 and 8 to record Total (allowable) SNAP-Ed Expenditures.
This total should equal Line 3 in Question 10, Expenditures by Category of Spending.

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10. Expenditures by Category of Spending (See Instructions below)
Cost breakouts for item #10 may be the actual allocation or estimated.
1. Total Expenditures for SNAP-Ed Program Delivery

$

2. Total Expenditures for Administrative Costs

$

3. TOTAL SNAP-Ed Expenditures (State and Federal)

$

Data provided in this table are (check one):

actual or

estimated based on FTE allocation.

Instructions for Question 10
Costs reported in this table may be calculated based on: 1) the actual expenditures associated with each
component described above; or, 2) be estimated based on multiplying the percentage of total FTE time
spent on nutrition education versus administration to any cost component that is not tracked separately as
a delivery or administrative expense.
Example: 45% of FTEs are for administrative functions. Apply this to the total expenditures and you can
estimate your Total Expenditures for Administrative Costs, line 2.
Line 1: Count all of the following as Nutrition Education Program Delivery Expenditures:
o Dollar value of salaries and benefits associated with staff time spent providing approved and
allowable SNAP-Ed activities.
o Cost of all food demonstration supplies.
o Cost of purchasing and/or developing educational materials (literature/materials/audiovisuals.
o Cost of developing and implementing media campaigns.
o Dollar value of the pro-rated costs of space used to deliver SNAP-Ed.
o Cost of any SNAP-Ed evaluation efforts.
o Cost of traveling to deliver SNAP-Ed services.
o Cost of training for nutrition education providers.
o Indirect costs (must be proportionate to time spent to delivery of SNAP-Ed)
o Other overhead charges (space, HR services, etc).
Line 2: Count all of the following as FSN Administrative Expenditures:
o Dollar value of salaries and benefits associated with staff time spent on SNAP-Ed administration
not on nutrition education. (example: State SNAP/IA/Project staff, support staff).
o Cost of training to performing administrative functions like record keeping, accounting, etc.
o Cost of reporting.
o Cost of equipment and office supplies.
o Operating Costs.
o Indirect Costs for those administrative staff not covered above.
o Other overhead charges associated with administrative expenses (space, HR services, etc).
Line 3: Sum of lines 1 and 2. This total should equal the total reported in Line 9 of Question 9,
Expenditure by Sources of Funding.

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