State, Local, and Tribal Government (CN Agency Staff, State Medicaid Agency Staff, Other State Agency Staff, and School District Staff)

Evaluation of the Direct Certification with Medicaid for Free and Reduced-Price (DCM-F/RP) Meals Demonstration

OMB: 0584-0630

IC ID: 227121

Documents and Forms
Document Name
Document Type
Other-Appendix A-2 Site Visit Schedu
Other-Appendix A-3a Detailed Site Vi
Other-Appendix A-3.b Detailed Site V
Other-Appendix A-3.c Detailed Site V
Other-Appendix A-4 Site Visit Observ
Other-Appendix A.6a Detailed Follow-
Other-Appendix A-6.b Detailed Follow
Other-Appendix A-6.c Detailed Follow
Other-Appendix B.2 Administrative Re
Other-Appendix C-2 Instructions for
Other-Appendix C-3.a State Cost Data
Other-Appendix C-3.b Medicaid State
Other-Appendix C-4 State Cost Data C
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

State, Local, and Tribal Government (CN Agency Staff, State Medicaid Agency Staff, Other State Agency Staff, and School District Staff)
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Appendix A-2 Site Visit Scheduling Call Protocol A2 DCM-FRP Site Visit Scheduling Call.docx No   Paper Only
Other-Appendix A-3a Detailed Site Visit Interview Protocol: State Child Nutrition Agency Staff A3a DCM-FRP CN Site Visit Protocol.docx No   Paper Only
Other-Appendix A-3.b Detailed Site Visit Interview Protocol: State Medicaid Agency Staff A3b DCM-FRP Medicaid Site Visit Protocol.docx No   Paper Only
Other-Appendix A-3.c Detailed Site Visit Interview Protocol: District Staff A3c DCM-FRP District Site Visit Protocol.docx No   Paper Only
Other-Appendix A-4 Site Visit Observation Protocol A4 DCM-FRP Site Visit Observation Protocol.docx No   Paper Only
Other-Appendix A.6a Detailed Follow-Up Telephone Interview Protocol: State Child Nutrition Agency Staff A6a DCM-FRP CN FollowUp Protocol.docx No   Paper Only
Other-Appendix A-6.b Detailed Follow-Up Telephone Interview Protocol: State Medicaid Agency Staff A6b DCM-FRP Medicaid FollowUp Protocol.docx No   Paper Only
Other-Appendix A-6.c Detailed Follow-Up Telephone Interview Protocol: District Staff A6c DCM-FRP District FollowUp Protocol.docx No   Paper Only
Other-Appendix B.2 Administrative Records Request B2 DCM-FRP Admin Records Request.docx Yes No Fillable Printable
Other-Appendix C-2 Instructions for State Cost Data Tracking Logs C2 DCM-FRP Cost Log Instructions.docx Yes No Fillable Printable
Other-Appendix C-3.a State Cost Data Tracking Logs C3a DCM-FRP CN Cost Log.xlsx Yes No Fillable Printable
Other-Appendix C-3.b Medicaid State Cost Data Tracking Logs C3b DCM-FRP Medicaid Cost Log.xlsx Yes No Fillable Printable
Other-Appendix C-4 State Cost Data Clarification Call C4 DCM-FRP Cost Log Clarification Protocol.docx No   Paper Only

Income Security Food and Nutrition Assistance

FNS-8 USDA/FNS Studies and Reports  56 FR 19078

195 96
   
State, Local, and Tribal Governments
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 1,532 0 444 0 0 1,088
Annual IC Time Burden (Hours) 1,961 0 792 0 0 1,169
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Appendix A.1 Site Visit Letter A1 DCM-FRP_Site Visit Intro Letter.docx 06/16/2017
Appendix A-2.a Site Visit Preparation: State Child Nutrition Agency A2a Site Visit Materials_CN agency.docx 06/16/2017
Appendix A-2.b Site Visit Preparation: State Medicaid Agency A2b Site Visit Materials_Medicaid agency.docx 06/16/2017
Appendix A-2.c Site Visit Preparation: District A2c Site Visit Materials_District.docx 06/16/2017
Appendix A.5 Site Visit Follow Up Telephone Interview Email A5 DCM-FRP Site Visit Follow Up Phone Interview Email.docx 06/16/2017
Appendix B.1 Administrative Records Request Emails B1 DCM-FRP Admin Records Request Emails.docx 04/03/2019
Appendix C-1 State Cost Data Collection Email C1 DCM-FRP Cost Log Emails.docx 04/03/2019
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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