Appendix 5 - Updated Burden Narrative_SNAP-Ed Toolkit Intervention Submission Form Scoring Tool 6-30-2021

Appendix 6: Burden Narrative

Reporting Requirements--Part 272

Reporting Requirements for Participating State Agencies

272.2(d)(2)(D), Planning Documents, SNAP-Ed Activities. Developers of nutrition education and obesity prevention interventions may submit an Intervention Submission Form (FNS-886) to have their interventions reviewed by intervention reviewers using the Scoring Tool (FNS-885) to determine if their interventions are sufficiently evidence-based for entry into the Supplemental Nutrition Assistance Program Education (SNAP-Ed) SNAP-Ed Strategies and Interventions: An Obesity Prevention Toolkit for States(Toolkit).

In 2019, 66 respondents completed the Scoring Tool (FNS-885). Twenty (20) respondents completed FNS-885 in 2020. For the Burden Table, the average number of respondents in 2019 and 2020 was used, or a total of 43 respondents. Responses reflected a larger number of respondents from non-profit businesses and a smaller number of respondents from State, local, and Tribal governments than initially expected, which is reflected in the Burden Table. Three respondents from non-profit businesses, and two respondents who are employees of the Federal government pilot-tested the revised FNS-885 and spent an average of two hours to complete the revised form. The three respondents from non-profit businesses are reflected in the Burden Table. The Burden Table for the Scoring Tool (FNS-885) reflects two hours for each completion of the form. Each respondent to FNS-885 also completes a one-hour training webinar, which has been included in the Burden Table. FNS predicts that the total annual burden hours for the Scoring Tool (FNS-885) will be 235 hours per year. The names, titles, and organizations of employment for pilot-testers of the Scoring Tool (FNS-885) are listed in the table below.

Name	Title	Organization
Kakul Joshi, MPH	PhD Candidate	Department of Population and Quantitative Health Sciences, Case Western Reserve University
Judith Dodd, MS, RDN, LDN, FAND	Assistant Professor	University of Pittsburgh
Jenna Seymour, PhD	Senior Policy Advisor	Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention
Marci Scott, PhD, RDN	Vice President of Programs	Michigan Fitness Foundation
Deborah Young Hyman, PhD	Health Scientist Administrator	Office of Behavioral and Social Science Research Office of the Director, NIH

In 2019, 75 respondents completed the FNS-886, or Intervention Submission Form. 22 respondents completed FNS-886 in 2020. For the Burden Table, the average number of respondents in 2019 and 2020 was used, or 49 total respondents. Responses reflected a larger number of respondents from non-profit businesses and a smaller number of respondents from State, local, and Tribal governments than initially expected, which is reflected in the Burden Table. Three respondents from non-profit businesses pilot-tested the revised FNS-886 and reported an average of six hours to complete the revised form. The Burden Table for the Intervention Submission Form (FNS-886) reflects six hours for each completion of the form. Each respondent to the FNS-886 also completes a one-hour training webinar, which has been included in the Burden Table. FNS predicts that the total annual burden hours for the Intervention Submission Form (FNS-886) will be 315 hours per year. The names, titles, and organizations of employment for pilot-testers of the Intervention Submission Form (FNS-886) are listed in the table below.

Name	Title	Organization	Name of Intervention
Amanda S. Hege	Project Manager, Sustainable Food Systems	Academy of Nutrition and Dietetics Foundation	Farm Fresh
Erin Croom	Co-Founder	Small Bites Adventure Club	Taste Test Box (Small Bites Adventure Club)
Staci K Emm	Extension Educator	Mineral County Cooperative Extension, University of Nevada, Reno	Veggies for Kids Grow Strong

Recordkeeping Requirements—There are no Recordkeeping Requirements for this Information Collection

Public Disclosure Requirements—There are no Public Disclosure Requirements for this Information Collection

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