Information Collection

FNS Core Nutrition Messages and Supporting Content Testing-Phase 2

IC 184699 under ICR 200712-0584-003 · OMB 0584-0524.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0524 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
attachmentA_screeners3-24.doc	Other-Screening Questionnaire-Low In
attachment A_Screener LIM-June 2008.doc	Other-Screening Questionnaire Low In
AttachmentB_Instrument_revkidscreener.doc	Other-Screening Questionnaire for Lo
attachmentC_pmomguide1-MAR-24.doc Focus Group Guide Low-income Mother of 2-5 years old	IC Document
attachC_Handout 1.doc Attachment C-Handout 1	IC Document
attachC_Handout 2.doc Attachment C-Handout 2	IC Document
attachC_Handout 3.doc Attachment C-Handout 3	IC Document
attachmentD_pmomguide2-MAR-24.doc Attachment D-Gocus Group Guide (Low-income Mothers)	IC Document
attachD_Handout 1 comb.pdf Attachment D-Handout 1	IC Document
attachD_Handout 2.doc Attachment D-Handout 2	IC Document
attachD_Handout 3.doc Attachment D-Handout 3	IC Document
attachD_Handout 4.doc Attachment D-Handout 4	IC Document
attachmentE_emomguide-MAR-24.doc Attachment E (Low-income Mothers 6-10 years old)	IC Document
attachE_Handout 1.doc Attachment E-Handout 1	IC Document
attachE_Handout 2.doc Attachment E-Handout 2	IC Document
attachE_Handout 3.doc Attachment E-Handout 3	IC Document
attachmentF_kidguide-MAR-24.doc Attachment F: Moderator's Guide In-person Kid Focus group	IC Document
attachF_visuals.pdf Attachment F Handouts 1-8	IC Document
attachmentG_pmomguidejune-APR7.doc Attachment G: Focus Group Guide (Low-income Mothers)	IC Document
attachG_Handout 1 comb.pdf Attachment G-Handout 1	IC Document
attachG_Handout 2.doc Attachment G: Handout 2	IC Document
attachG_Handout 3.doc Attachment G: Handout 3	IC Document
attachmentH_mconfident3-24.doc Attachment H: Confidentiality Agreement	IC Document
attachmentI_pconfident3-24.docx Attachment I: Confidentiality Agreement (Mothers of Children)	IC Document
AttachmentJ_parentconsent-MAR-24.doc Attachment J: Parent Permission Form	IC Document
Core Nutrition Phase II burden hours.xls Burden Table	IC Document
Division of Feeding Responsibiltiy Eval_Sub-AttachG-Handout 3.doc Divison of Feeding Attachment G sub handout	IC Document
Division of Feeding Responsibiltiy Eval_Sub-Attach G-Handout 2 (2).doc Division of Feeding Attach G sub-handout 2	IC Document
Division of Feeding Responsibiltiy Eval_Sub-Attach G-Handout 1.pdf Division of Feeding Attachment G-Sub Handout 1	IC Document
coremessagesomb4-7.doc Supporting Statement Memo	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

FNS Core Nutrition Messages and Supporting Content Testing-Phase 2

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 7 CFR 2.19

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Electronic Capability
Other-Screening Questionnaire for Low-Income Children	AttachmentB_Instrument_revkidscreener.doc	No	Paper Only
Other-Screening Questionnaire-Low Income Mother (May 2008)	attachmentA_screeners3-24.doc	No	Paper Only
Other-Screening Questionnaire Low Income Mother-June 2008	attachment A_Screener LIM-June 2008.doc	No	Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3,960

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	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	3,960	0	0	0	0	0
Annual IC Time Burden (Hours)	945	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Focus Group Guide Low-income Mother of 2-5 years old	attachmentC_pmomguide1-MAR-24.doc	04/30/2008
Attachment C-Handout 1	attachC_Handout 1.doc	04/30/2008
Attachment C-Handout 2	attachC_Handout 2.doc	04/30/2008
Attachment C-Handout 3	attachC_Handout 3.doc	04/30/2008
Attachment D-Gocus Group Guide (Low-income Mothers)	attachmentD_pmomguide2-MAR-24.doc	04/30/2008
Attachment D-Handout 1	attachD_Handout 1 comb.pdf	04/30/2008
Attachment D-Handout 2	attachD_Handout 2.doc	04/30/2008
Attachment D-Handout 3	attachD_Handout 3.doc	04/30/2008
Attachment D-Handout 4	attachD_Handout 4.doc	04/30/2008
Attachment E (Low-income Mothers 6-10 years old)	attachmentE_emomguide-MAR-24.doc	04/30/2008
Attachment E-Handout 1	attachE_Handout 1.doc	04/30/2008
Attachment E-Handout 2	attachE_Handout 2.doc	04/30/2008
Attachment E-Handout 3	attachE_Handout 3.doc	04/30/2008
Attachment F: Moderator's Guide In-person Kid Focus group	attachmentF_kidguide-MAR-24.doc	04/30/2008
Attachment F Handouts 1-8	attachF_visuals.pdf	04/30/2008
Attachment G: Focus Group Guide (Low-income Mothers)	attachmentG_pmomguidejune-APR7.doc	04/30/2008
Attachment G-Handout 1	attachG_Handout 1 comb.pdf	04/30/2008
Attachment G: Handout 2	attachG_Handout 2.doc	04/30/2008
Attachment G: Handout 3	attachG_Handout 3.doc	04/30/2008
Attachment H: Confidentiality Agreement	attachmentH_mconfident3-24.doc	04/30/2008
Attachment I: Confidentiality Agreement (Mothers of Children)	attachmentI_pconfident3-24.docx	04/30/2008
Attachment J: Parent Permission Form	AttachmentJ_parentconsent-MAR-24.doc	04/30/2008
Burden Table	Core Nutrition Phase II burden hours.xls	04/30/2008
Divison of Feeding Attachment G sub handout	Division of Feeding Responsibiltiy Eval_Sub-AttachG-Handout 3.doc	04/30/2008
Division of Feeding Attach G sub-handout 2	Division of Feeding Responsibiltiy Eval_Sub-Attach G-Handout 2 (2).doc	04/30/2008
Division of Feeding Attachment G-Sub Handout 1	Division of Feeding Responsibiltiy Eval_Sub-Attach G-Handout 1.pdf	04/30/2008
Supporting Statement Memo	coremessagesomb4-7.doc	04/30/2008

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.