Appendix B: FFVP CFD Burden Table

Evaluation of the Canned, Frozen, or Dried Fruits and Vegetables Pilot Project in the FFVP
Appendix B SAMPLE RESPONDENT BURDEN TABLE
Affected
Public

Appendix # for Each Data Collection Activity

C.1a
State
C.1b

Mode

Email - Study Introduction, Survey Invitation - State Child
Nutrition Directors
Survey - State Child Nutrition (CN) Directors

Self-administered, editable,
PDF

Respondents

State Child
Nutrition
Directors

C.2b

Self-administered, editable,
PDF

C.3b

Email – Study Introduction, Survey Invitation – Food
Service Managers (FSM)
Survey- Food Service Managers (FSM)

Self-administered, PDF

C.3c

Daily Meal Counts Form

Self-administered, paper

School-Level Reimbursable Fruit and Vegetable Form

Self-administered, paper

Prototype FFVP/Monthly Reimbursement Claims Form
(three months)
Letter – Study Introduction – Principals

Collect document

C.3a

C.3d
D.3
Local and
Tribal

Email – Study Introduction, Survey Invitation – School
Food Authority (SFA) Directors
Survey – School Food Authority (SFA) Directors

C.4a
C.4a1

C.5a
C.5b
C.6a

B. 2

C.6b

Survey – Principals

Private

Letter – Study Introduction, Survey Invitation – Classroom
Teachers
Survey – Classroom Teachers
Self-administered, paper
Letter/Email – Study Introduction, Schedule Interview –
Stakeholders
Protocol – Qualitative Telephone – Stakeholders

Semi-structured telephone
interview

Self-administered, editable,
PDF

Self-administered, PDF

C.3c

Daily Meal Counts Form

Self-administered, paper

School-Level Reimbursable Fruit and Vegetable Form

Self-administered, paper

Prototype FFVP/Monthly Reimbursement Claims Form
(three months)
Letter – Study Introduction – Principals

Collect document

C.4a
C.4a1

Telephone Script – Principals / School Staff

C.4c

Email – Survey Invitation – Principals

C.5a
C.5b
C.6a

Nonresponse
Total Annual
Responses

Average
Total Annual Grand Total
Burden Hours
Burden
Annual
Burden
per Response Estimate
(hours)
Estimate
(hours)

Hourly
Wage
Rate

Total
Annualized Cost
of Respondent
Burden

a

1

43

0.25

10.8

11

2

22

0.05

1.08

12

54

43

1

43

0.25

10.8

11

2.00

22

0.05

1.08

12

48

38

2

77

0.33

25.3

10

2

19

0.05

0.96

26

$39.37

$1,036

98

78

2

157

0.17

26.1

20

2

39

0.05

1.96

28

$25.28

$710

98

98

2

196

0.08

16.3

0

2

0

0.05

0.00

16

$25.28

$413

98

98

2

196

0.42

81.7

0

2

0

0.05

0.00

82

$25.28

$2,065

98

2

196

0.08

16.3

0

2

0

0.05

0.00

16

$25.28

$413

98

98

1

98

0.33

32.3

0

2

0

0.05

0.00

32

$42.38

$1,371

98

78

2

157

0.17

26.7

20

2

39

0.05

1.96

29

$42.38

$1,213

Classroom
Teacher

244

195

2

390

0.17

65.1

49

2

98

0.05

4.88

70

$42.38

$2,964

Stakeholders

60

48

1

48

1.00

48.0

12

2

24

0.05

1.20

49

$34.34

940

830

1.82

1,515

0.22

337.9

110

2.00

219

0.05

11

349

2

2

2

4

0.33

1.3

0

2

0

0.05

0.00

1

$39.37

$52

2

2

2

4

0.17

0.7

0

2

0

0.05

0.00

1

$25.28

$17

2

2

2

4

0.08

0.3

0

2

0

0.05

0.00

0

$25.28

$8

2

2

2

4

0.42

1.7

0

2

0

0.05

0.00

2

$25.28

$42

2

2

4

0.08

0.3

0

2

0

0.05

0.00

0

$25.28

$8

2

2

1

2

0.33

0.7

0

2

0

0.05

0.00

1

$42.38

$28

2

2

2

4

0.17

0.7

0

2

0

0.05

0.00

1

$42.38

$29

Classroom
Teacher

6

5

2

10

0.17

1.6

1

2

2

0.05

0.12

2

$42.38

$73

Stakeholders

3

2

1

2

1 00

24

1

2

1

0 05

0 06

2

$34 34

School Food
Authority (SFA)
Directors

Food Service
Managers
(FSMs)

Collected from
FSM

School Food
Authority (SFA)
Directors

Food Service
Managers
(FSMs)

Collected from
FSM

Frequently Asked Questions by Schools

C.4b

C.4d

Freq. of
Response

43

Self-administered, editable,
PDF

C.3b

D.3

Total Annual Estimated Number
Burden
of Respondents
Estimate
(hours)

98

$42.98

$511

$511

Email – Survey Invitation – Principals

Email – Study Introduction, Survey Invitation – Food
Service Managers (FSM)
Survey- Food Service Managers (FSM)

C.3d

Average
Burden Hours
per Response

Principal

Subtotal - Local and Tribal
Email – Study Introduction, Survey Invitation – School
C.2a
Food Authority (SFA) Directors
Survey – School Food Authority (SFA) Directors
C.2b
C.3a

Respondents
Total Annual
Responses

Telephone

C.4b

C.4d

Freq. of
Response

Frequently Asked Questions by Schools
Telephone Script – Principals / School Staff

C.4c

Estimated Number
of Respondents

54

Subtotal - State
C.2a

Sample

Survey – Principals

Telephone

Letter/Email – Study Introduction, Schedule Interview –
Stakeholders

$1,690
$11,873

Principal

Self-administered, editable,
PDF

Letter – Study Introduction, Survey Invitation – Classroom
Teachers
Survey – Classroom Teachers
Self-administered, paper

2

b

b

$84

Evaluation of the Canned, Frozen, or Dried Fruits and Vegetables Pilot Project in the FFVP
Appendix B SAMPLE RESPONDENT BURDEN TABLE
Affected
Public

Appendix # for Each Data Collection Activity

C.6b

Protocol – Qualitative Telephone – Stakeholders

Mode

Semi-structured telephone
interview

Subtotal - Private
E.1a1 Letter – Study Introduction, Study Notification “implied
consent” (English)
Letter – Study Introduction, Study Notification “implied
E.1a2
consent” (Spanish)
Letter – Study Introduction, Instructions for “active
E.1b1
consent” form (English)
Letter – Study Introduction, Instructions for “active
E.1b2
consent” form (Spanish)
Telephone Script – Verbal Consent (English)
E.1c1
E1c2

Telephone Script – Verbal Consent (Spanish)

Letter – Study Introduction, Survey Invitation- Parent
(English)
Letter – Study Introduction, Survey Invitation- Parent
E.2a2
(Spanish)
E.2b1 Survey – Parent (English)
E.2b2 Survey – Parent (Spanish)

Respondents

Stakeholders

Sample

Estimated Number
of Respondents

Freq. of
Response

Respondents
Total Annual
Responses

Average
Burden Hours
per Response

Total Annual Estimated Number
Burden
of Respondents
Estimate
(hours)

Freq. of
Response

Nonresponse
Total Annual
Responses

Average
Total Annual Grand Total
Burden Hours
Burden
Annual
Burden
per Response Estimate
(hours)
Estimate
(hours)

Hourly
Wage
Rate

Total
Annualized Cost
of Respondent
Burden

a

3

2

1

2

1.00

2.4

1

2

1

0.05

0.06

2

$34.34

23

21

1.79

38

0.25

9.7

2

2.00

4

0.05

0

10

5,000

3,750

1

3,750

0.17

625.0

1,250

2

2,500

0.05

125.00

750

$22.01

$16,508

5,000

4,000

2

8,000

0.17

1,333.3

1,000

2

2,000

0.05

100.00

1,433

$22.01

$31,548

3,750

3,562

2

7,123

0.33

2,374.3

189

2

377

0.05

18.85

2,393

$0.00

c

$0

3,000

2,850

2

5,700

0.17

950.0

150

2

300

0.05

15.00

965

$0.00

c

$0

3,300

3,135

2

6,270

0.33

2,090.0

165

2

330

0.05

16.50

2,107

$0.00

c

$0

3,300

3,135

2

6,270

0.33

2,090.0

165

2

330

0.05

16.50

2,107

$0.00

c

$0

23,350

20,432

1.82

37,113

0.25

9,462.7

2,919

2.00

5,837

0.05

292

9,755

b

$84

$342

Parent
Self-administered, paper

E.2a1
Individual

E.3a

Self-administered, paper

Administration Script - Assent and Survey -Student

B. 3

E.3b1 Assent – Student (English)
E.3b2 Assent – Student (Spanish)
E.3c
E.4a
E.4b
E.4c

Survey – Student

Self-administered, paper

Foods Eaten at School Today (FEST) Diary – Training
Script
Foods Eaten at School Today (FEST) Diary Recall
Self-administered, paper
In-person diary-assisted (FEST) dietary recall for
consumption in school only using electronic multiple pass In-person - CAPI
approach

Subtotal - Individual

Student

$48,055

Grand Total
24,367
21,326
1.82
38,709
0.25
9,821.0
3,041
2.00
6,081
0.05
304.07
10,125
$60,781
Notes: "Total Annualized Cost of Respondent Burden" is equal to the "Grand Total Annual Burden Estimate (hours)" times an average hourly wage rate. The following forms will be completed by contractor staff and are not reported in the respondent burden table: (1) Nutrition Education, Promotional Material, and Menu Collection Form
(Appendix D1); and (2) Classroom-Student Level Fruit and Vegetable Observation Form for Snacks and Recall and Plate Waste (Appendix D2).
a. Average hourly wage rates are taken from: Bureau of Labor Statistics, Wages by Occupation, May 2012. Rates used included State Child Nutrition Directors at $42.98; School Foodservice Director (SFA) or LEA Business Manager - (Education Administrators, All Other) at $39.37; Principal (Education Administrators) at $42.38;
Stakeholders (hourly wage rate based on 1/10 of the interviews to be conducted with State Child Nutrition Directors at $42.98; 2/10 with Food Service Managers at $25.28, 2/10 with SFA Directors at $39.37, 3/10 with Principals and Teachers at $42.38, and 2/10 with general population (All Occupations) at $22.01, for a total of $34.34.
Parent (All Occupations) - $22.01.
b. Stakeholders (hourly wage rate based on 1/10 of the interviews to be conducted with State Child Nutrition Directors at $42.98; 2/10 with Food Service Managers at $25.28, 2/10 with SFA Directors at $39.37, 3/10 with Principals and Teachers at $42.38, and 2/10 with general population (All Occupations) at $22.01, for a total of $34.34.
c. Students (elementary and secondary school students) were assumed to not have an hourly wage rate.