Businesses - Sponsors and Providers

Study of Nutrition and Activity in Child Care Settings

OMB: 0584-0615

IC ID: 218953

Documents and Forms

Document Name Document Type
Appendix D1a Provider Web Survey Final 10.7.16.docx Other-Appendix D1a Provider Web Surv
Appendix D2a Menu Survey Final 11.2.15.docx Other-Appendix D2a Menu Survey
Appendix D2b Infant Menu Survey Final 11.2.15.docx Other-Appendix D2b Infant Menu Surve
Appendix D2c Food Description Guide.docx Other-Appendix D2c Food Description
Appendix D2e Menu Survey Training Video.docx Other-Appendix D2e Menu Survey Train
Appendix D3 Reference Portion Measurement Form.docx Other-Appendix D3 Reference Portion
Appendix D4a Meal Observation Form--Meals Served by Provider Final 11 3 15.docx Other-Appendix D4a Meal Observation
Appendix D4b Meal Observation Form--Meals Brought From Home Final 11.2.15.docx Other-Appendix D4b Meal Observation
Appendix D5 Classroom Waste Observation Form.docx Other-Appendix D5 Classroom Waste Ob
Appendix D6 Enviromental Observation Form.docx Other-Appendix D6 Environmental Obse
Appendix E3 Infant Food Intake Form Final 11.2.15.docx Other-Appendix E3 Infant Food Intake
Appendix F1. Pre Visit Cost Telephone Interview.docx Other-Appendix F1. Pre Visit Cost Te
Appendix F2. Pre Visit Cost Form.docx Other-Appendix F2. Pre Visit Cost Fo
Appendix F3 Sponsor Cost Interview Final 11.2.15.docx Other-Appendix F3 Sponsor Cost Inter
Appendix F4 Center Director Cost Interview Final 11.3.15.docx Other-Appendix F4 Center Director Co
Appendix F5 Center Foodservice Cost Interview.docx Other-Appendix F5 Center Foodservice
Appendix C2 Study Fact Sheet.docx Appendix C2 Study Fact Sheet IC Document
Appendix C3 Study Endorsement Letter from USDA Final_3.10.16.pdf Appendix C3 Study Endorsement Letter from USDA Final 3.10.16 IC Document
Appendix C4 Study Endorsement Letter.pdf Appendix C4 Study Endorsement Letter from the President of the CACFP Forum IC Document
Appendix C5 Sponsor Recruitment Letter and Call Script_Final 3.9.16.docx Appendix C5 Sponsor Recruitment Letter and Call Script IC Document
Appendix C.6a Study Brochure _ENG Final 10.30.15.pdf Appendix C.6a Study Brochure (English) IC Document
Appendix C6b Study Brochure Spanish_Final 10.30.15.pdf Appendix C.6b Study Brochure (Spanish) IC Document
Appendix C7 Provider Recruitment Letter and Call Script v2 Final 10.7.16.docx Appendix C7 Provider Recruitment Letter and Call Script IC Document
Appendix D1b Provider Web Survey Related Comm Final 10.30.15.docx Appendix D1b Provider Web Survey Related Communications IC Document
Appendix D2d Menu Survey Related Comm Final 11.2.15.docx Appendix D2d Menu Survey Related Communications IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Businesses - Sponsors and Providers	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Appendix D1a Provider Web Survey	Appendix D1a Provider Web Survey Final 10.7.16.docx	Yes	Yes	Fillable Fileable
Other-Appendix D2a Menu Survey	Appendix D2a Menu Survey Final 11.2.15.docx	No		Paper Only
Other-Appendix D2b Infant Menu Survey	Appendix D2b Infant Menu Survey Final 11.2.15.docx	No		Paper Only
Other-Appendix D2c Food Description Guide	Appendix D2c Food Description Guide.docx	No		Paper Only
Other-Appendix D2e Menu Survey Training Video	Appendix D2e Menu Survey Training Video.docx	Yes	No	Printable Only
Other-Appendix D3 Reference Portion Measurement Form	Appendix D3 Reference Portion Measurement Form.docx	No		Paper Only
Other-Appendix D4a Meal Observation Form - Meals Served by Provider	Appendix D4a Meal Observation Form--Meals Served by Provider Final 11 3 15.docx	No		Paper Only
Other-Appendix D4b Meal Observation Form--Meals Brought From Home	Appendix D4b Meal Observation Form--Meals Brought From Home Final 11.2.15.docx	No		Paper Only
Other-Appendix D5 Classroom Waste Observation Form	Appendix D5 Classroom Waste Observation Form.docx	No		Paper Only
Other-Appendix D6 Environmental Observation Form	Appendix D6 Enviromental Observation Form.docx	No		Paper Only
Other-Appendix E3 Infant Food Intake Form	Appendix E3 Infant Food Intake Form Final 11.2.15.docx	No		Paper Only
Other-Appendix F1. Pre Visit Cost Telephone Interview	Appendix F1. Pre Visit Cost Telephone Interview.docx	Yes	Yes	Fillable Fileable
Other-Appendix F2. Pre Visit Cost Form	Appendix F2. Pre Visit Cost Form.docx	No		Paper Only
Other-Appendix F3 Sponsor Cost Interview	Appendix F3 Sponsor Cost Interview Final 11.2.15.docx	No		Paper Only
Other-Appendix F4 Center Director Cost Interview	Appendix F4 Center Director Cost Interview Final 11.3.15.docx	No		Paper Only
Other-Appendix F5 Center Foodservice Cost Interview	Appendix F5 Center Foodservice Cost Interview.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 USDA/FNS Studies and Reports	FR Citation: 56 FR 19078

Number of Respondents: 3,343	Number of Respondents for Small Entity: 3,290

Affected Public: Private Sector	Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 21 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	8,196	8,196
Annual IC Time Burden (Hours)	10,063	10,063
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Appendix C2 Study Fact Sheet	Appendix C2 Study Fact Sheet.docx	11/13/2015
Appendix C3 Study Endorsement Letter from USDA Final 3.10.16	Appendix C3 Study Endorsement Letter from USDA Final_3.10.16.pdf	03/10/2016
Appendix C4 Study Endorsement Letter from the President of the CACFP Forum	Appendix C4 Study Endorsement Letter.pdf	11/13/2015
Appendix C5 Sponsor Recruitment Letter and Call Script	Appendix C5 Sponsor Recruitment Letter and Call Script_Final 3.9.16.docx	03/10/2016
Appendix C.6a Study Brochure (English)	Appendix C.6a Study Brochure _ENG Final 10.30.15.pdf	11/13/2015
Appendix C.6b Study Brochure (Spanish)	Appendix C6b Study Brochure Spanish_Final 10.30.15.pdf	11/13/2015
Appendix C7 Provider Recruitment Letter and Call Script	Appendix C7 Provider Recruitment Letter and Call Script v2 Final 10.7.16.docx	10/07/2016
Appendix D1b Provider Web Survey Related Communications	Appendix D1b Provider Web Survey Related Comm Final 10.30.15.docx	11/13/2015
Appendix D2d Menu Survey Related Communications	Appendix D2d Menu Survey Related Comm Final 11.2.15.docx	11/13/2015

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