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State Agency Notification of Major Changes in Program Design Form

EO Guidance Document #
Resource type
Resource Materials
Word Icon Form (278.20 KB)

This form should be used by state agencies to notify FNS of a major change per the Review of Major Changes in Program Design and Management Evaluation Systems final rule.

April 25, 2016 - This document is now obsolete.

For a complete list of guidance and memos related to this rule please see

Notification Deadline

State agencies must notify FNS when major changes have been approved by the appropriate state authority but no less than 120 days prior to beginning implementation of the change or entering into a contract. If the state is unable to meet the 120 day deadline, they must notify FNS as soon as they are aware of the change and explain why they could not meet the deadline.

Submission Instructions

E-mail completed forms to with a copy to your FNS regional office.


E-mail questions about this form to with a copy to your FNS regional office.

Page updated: January 30, 2023

The contents of this guidance document do not have the force and effect of law and are not meant to bind the public in any way. This document is intended only to provide clarity to the public regarding existing requirements under the law or agency policies.