SNAP-Ed Toolkit Submission Form and Scoring Tool

Forms and Documents

Document Name	Status
Form FNS 885 Business for and not for profit Form and Instruction	New
Form FNS 885 State, Local and Tribal Agencies Form and Instruction	New
Appendix 11 - 7 CFR 272-2 d 2 excerpt.docx Supplementary Document	2018-01-29
Appendix 10 - Food And Nutrition Act 2008 Section 28-c-3-excerpt.docx Supplementary Document	2018-01-29
Clean Copy - SNAP-Ed Toolkit Intervention Submission Form and Scoring Tool Supporting Statement Part A 6-6-18 (OIRA Passback).docx Supporting Statement A	2018-06-13
Appendix 4 Burden Narrative.docx Supplementary Document	2018-01-11
Appendix 3 Burden Table - SNAP-Ed Toolkit Intervention Submission Form & Scoring Tool.xlsx Supplementary Document	2018-01-11

IC Document Collections

IC ID	Document Title	Status
229729	Business for and not for profit Form and Instruction	New
229727	State, Local and Tribal Agencies Form and Instruction	New

ICR Details

OMB Control No: 0584-0639	ICR Reference No: 201801-0584-001
Status: Active	Previous ICR Reference No:
Agency/Subagency: USDA/FNS	Agency Tracking No:
Title: SNAP-Ed Toolkit Submission Form and Scoring Tool
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 06/15/2018
	Date Received in OIRA: 03/08/2018
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2021	36 Months From Approved
Responses	160	0	0
Time Burden (Hours)	668	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: SNAP-Ed State and Implementing Agencies can and will identify and choose evidence-based activities (interventions) using the SNAP-Ed Strategies and Interventions: An Obesity Prevention Toolkit for States (Toolkit). The Toolkit is a publicly-available online searchable database of interventions which have been peer-reviewed to confirm that they are evidence-based for use in SNAP-Ed nutrition education and physical activity promotion activities.

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Authorizing Statute(s): US Code: 7 USC § 28(c)(3)(A) Name of Law: The Food and Nutrition Act of 2008
   PL: Pub.L. 113 - 79 SEC. 28. 7 U.S.C. 2036a Name of Law: FOOD AND NUTRITION ACT OF 2008
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 39404	08/18/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 9825	03/08/2018
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
State, Local and Tribal Agencies	FNS 886, FNS 885	SNAP-ED TOOLKIT INTERVENTION SCORING TOOL ,   SNAP-ED TOOLKIT INTERVENTION SUBMISSION FORM
Business for and not for profit	FNS 886, FNS 885	SNAP-ED TOOLKIT INTERVENTION SCORING TOOL ,   SNAP-ED TOOLKIT INTERVENTION SUBMISSION FORM

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	160	0	0	160	0	0
Annual Time Burden (Hours)	668	0	0	668	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new information collection request which will add 668 burden hours and 160 responses to the FNS OMB inventory due to program changes.

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Annual Cost to Federal Government: $11,641

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 03/08/2018

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