Generic Clearance to Conduct Formative Research

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form FNS 793 FNS Core Nutrition Messages-Feedback Form	Form	New	Available
Form FNS 792 Golden Grocer Award Nomination Form	Form	New	Available
Form FNS 791 USDA/FNS Promising Practices Submission Form	Form	New	Available
Form FNS 790 Hunger Champions in Administering the SNAP	Form and Instruction	New	Available
Form FNS-779 HealthierUS School Challenge Application for Gold or Gold w/ Distinction Awards	Form and Instruction	New	Available
Form FNS-780 Healthier US School Challenge Application for Bronze or Silver Awards	Form and Instruction	New	Available
Form FNS-781 Team Nutrition Enrollment Form	Form and Instruction	New	Available
ATTH 11 OMB Burden Statement.doc	Supplementary Document	Uploaded 2007-12-20	Available
Justification - User Response-Feedback-Request Forms 12 2007.doc	Justification for No Material/Nonsubstantive Change	Uploaded 2007-12-20	Available
0524 Justification Core Nutrition Message 9 20 07.doc	Justification for No Material/Nonsubstantive Change	Uploaded 2007-09-20	Available
OMB Burden Statement.doc	Supplementary Document	Uploaded 2006-12-27	Available
Dietary Guidelines Jan 05.pdf	Supplementary Document	Uploaded 2006-12-27	Available
#0584-0524 Supporting Statement.doc	Supporting Statement A	Uploaded 2007-09-20	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
190861	USDA FOODS PROGRAM	Other-Questionnaire	New
190593	OSIPO	Form	New	FNS Core Nutrition Messages-Feedback Form
190593	OSIPO	Form	New	Golden Grocer Award Nomination Form
190593	OSIPO	Form	New	USDA/FNS Promising Practices Submission Form
190593	OSIPO	Form and Instruction	New	Hunger Champions in Administering the SNAP
187682	HUSSC-TN 2009	Form and Instruction	New	HealthierUS School Challenge Application for Gold or Gold w/ Distinction Awards
187682	HUSSC-TN 2009	Form and Instruction	New	Healthier US School Challenge Application for Bronze or Silver Awards
187682	HUSSC-TN 2009	Form and Instruction	New	Team Nutrition Enrollment Form
184788	Food Stamp National Media Campaign Audience Assessment of Messages and Outreach Materials	Other-Participant Recruitment Screener Guide (Questionnaire)	New
184699	FNS Core Nutrition Messages and Supporting Content Testing-Phase 2	Other-Screening Questionnaire-Low Income Mother (May 2008)	New
184622	After You Deliver	Other-Questionnaire	New
183165	Individual - Response-Feedback-Request	Other-User Response	New
183162	SA/LA - User Response, Feedback, and Request Forms	Other-User Response	New

ICR Details

OMB Control No: 0584-0524	ICR Reference No: 200712-0584-003
Status: Historical Active	Previous ICR Reference No: 200709-0584-003
Agency/Subagency: USDA/FNS	Agency Tracking No:
Title: Generic Clearance to Conduct Formative Research
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 02/15/2008
Retrieve Notice of Action (NOA)	Date Received in OIRA: 01/09/2008
Terms of Clearance: This ICR is approved on the understanding that FNS is requesting approval for only the "user response, feedback" IC through this submission. Also, FNS agrees to keep a tally of the burden hours that remain after each IC submission. Previous terms of clearance remain in effect.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2010	03/31/2010	03/31/2010
Responses	19,000	0	19,000
Time Burden (Hours)	7,008	0	7,008
Cost Burden (Dollars)	0	0	0

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Abstract: Information collection is necessary to obtain formative input on the development of nutrition education materials and related tools for population groups served by the U.S. Department of Agriculture

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Authorizing Statute(s): PL: Pub.L. 108 - 269 17 Name of Law: Food Stamp Act of 1977
   PL: Pub.L. 109 - 85 17 Name of Law: Child Nutrition Act of 1966
   PL: Pub.L. 107 - 249 202-215 Name of Law: Emergency Food Assistance Act of 1983
   PL: Pub.L. 107 - 293 5 Name of Law: Agriculture and Consumer Protection Act of 1973
  

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:
	71 FR 38129	07/05/2006
30-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 232	12/04/2006
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 8

table that charts list of burden

IC Title	Form No.	Form Name
After You Deliver
FNS Core Nutrition Messages and Supporting Content Testing-Phase 2
Food Stamp National Media Campaign Audience Assessment of Messages and Outreach Materials
HUSSC-TN 2009	FNS-781, FNS-780, FNS-779	Team Nutrition Enrollment Form ,   Healthier US School Challenge Application for Bronze or Silver Awards ,   HealthierUS School Challenge Application for Gold or Gold w/ Distinction Awards
Individual - Response-Feedback-Request
OSIPO	FNS 791, FNS 792, FNS 790, FNS 793	Hunger Champions in Administering the SNAP ,   USDA/FNS Promising Practices Submission Form ,   Golden Grocer Award Nomination Form ,   FNS Core Nutrition Messages-Feedback Form
SA/LA - User Response, Feedback, and Request Forms
USDA FOODS PROGRAM

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ICR Summary of Burden

table that charts list 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	19,000	19,000	0	0	0	0
Annual Time Burden (Hours)	7,008	7,008	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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

Burden Increase Due to:

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

Burden Reduction Due to:

Short Statement: To meet the estimated future demand of FNS formative research needs there is an adjustment increase of 842 hours to the currently approved 6,166 hours for a total of 7,008 burden hours.

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Annual Cost to Federal Government: $155,464

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

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

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: 01/09/2008

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