SNAP-Ed Toolkit Submission Form and Scoring Tool (FNS 885 and FNS 886) w/ Screenshots

Forms and Documents

Document Name	Status
Form FNS 885 Business for (130) and not for profit (16) Form and Instruction	Modified
Form FNS 885 State, Local and Tribal Agencies Form and Instruction	Modified
Appendix 8 - FNS-8 FNS Studies and Reports.pdf Supplementary Document	2021-06-30
Appendix 7 - Legal Authority Name change form Food stamps to SNAP.pdf Supplementary Document	2021-06-30
Appendix 6 - Legal Authority 7 CFR(d)(2) SNAP-Ed.docx Supplementary Document	2021-06-30
Appendix 5 - Updated Burden Narrative_SNAP-Ed Toolkit Intervention Submission Form Scoring Tool 6-30-2021.docx Supplementary Document	2021-06-30
SNAP-Ed Toolkit Intervention Submission Form and Scoring Tool FNS 885 and 886 SSA FINAL 6-30-21.docx Supporting Statement A	2021-06-30
Appendix 4 - 2021 Updates_Burden Table_SNAP-Ed Toolkit Intervention Submission Form Scoring Tool ks edits.xlsx Supplementary Document	2021-06-30

IC Document Collections

IC ID	Document Title	Status
229729	Business for (130) and not for profit (16) Form and Instruction	Modified
229727	State, Local and Tribal Agencies Form and Instruction	Modified

ICR Details

OMB Control No: 0584-0639	ICR Reference No: 202106-0584-004
Status: Received in OIRA	Previous ICR Reference No: 201801-0584-001
Agency/Subagency: USDA/FNS	Agency Tracking No: Renewal 2021
Title: SNAP-Ed Toolkit Submission Form and Scoring Tool (FNS 885 and FNS 886) w/ Screenshots
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 06/30/2021

	Requested	Previously Approved
Expiration Date	36 Months From Approved	06/30/2021
Responses	231	160
Time Burden (Hours)	550	668
Cost Burden (Dollars)	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) FNS 885 and FNS 886. 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): PL: Pub.L. 113 - 79 SEC. 28. 7 U.S.C. 2036a Name of Law: FOOD AND NUTRITION ACT OF 2008
   US Code: 7 USC § 28(c)(3)(A) Name of Law: The 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:
	86 FR 22132	04/27/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 34713	06/30/2021
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
Business for (130) and not for profit (16)	FNS 885 , FNS 886, FNS 885	SNAP-ED TOOLKIT INTERVENTION SCORING TOOL ,   SNAP-ED TOOLKIT INTERVENTION SUBMISSION FORM ,   SNAP-ED TOOLKIT INTERVENTION SCORING TOOL
State, Local and Tribal Agencies	FNS 885 , FNS 886, FNS 885	SNAP-ED TOOLKIT INTERVENTION SCORING TOOL ,   SNAP-ED TOOLKIT INTERVENTION SUBMISSION FORM ,   SNAP-ED TOOLKIT INTERVENTION SCORING TOOL

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ICR Summary of Burden

	Total Request	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	231	160	0	21	50	0
Annual Time Burden (Hours)	550	668	0	183	-301	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 revision of a currently approved information collection request. The current inventory for this data collection is 127 respondents, 668 total annual burden hours and 160 total annual responses. There are 190 total annual respondents for this data collection this adjustment reflects an increase of 63 respondents. FNS is requesting 550 total annual burden hours and 231 total annual responses, an increase of 71 responses but a decrease of -118 total annual burden hours due to adjustments to the total number of respondents and program changes due to the modified instruments. These updated estimates have been developed based on data from real-world use of these forms, combined with reports from the pilot testing of the proposed revisions detailed in this information collection request.

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Annual Cost to Federal Government: $18,644

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? No

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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: 06/30/2021

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