NSLP/SBP Access, Participation, Eligibility, and Certification Study

OMB Approval No.: 0584-0530

Approval Expires:

^{NSLP AND SBP ACCESS, PARTICIPATION, ELIGIBILITY, AND}

CERTIFICATION STUDY (APEC-II)

MEAL TRANSACTION OBSERVATION FORM

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this collection is

0584-0530. The time required to complete this information collection is estimated to average 15 minutes per response, including the time to review instructions, searching existing data resources, gather the data needed, and complete and review the information collected.

_{SFA: | | | | |}

School: | | | | | Date: | | | / | | | / | | | | | MONTH DAY YEAR

Observer: | | | | | Time Began: | | | / | | | AM.............. 1

HOUR MINUTE PM.............. 2

Time Ended: | | | / | | | AM.............. 1

HOUR MINUTE PM.............. 2

NSLP AND SBP ACCESS, PARTICIPATION, ELIGIBILITY, AND CERTIFICATION STUDY (APEC-II)

MEAL TRANSACTION OBSERVATION FORM

Meal:  Breakfast

 Lunch

_{Meal Period:}

_{Serving Line/Cashier Sampled:}

_{Approximate Number of Transactions:}

_{First Person-Transaction to Observe:}

Sampling Interval: Take Every th Transaction After The First Selection

Total Count of Transactions Observed:

Record each food item offered and collect menu(s) for the meal being observed	Tray #: _
Food Items	Check if Food Item Taken	Number of Units Taken	Whether Reimbursable Meal Recorded by Cashier	Type of Participant
			 Yes  No	 Student  Non-student  Adult
			NOTES:

Prepared by Mathematica Policy Research, Inc.

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