Electronic Mailing List Subscription Form - Nutritions and Food Safety

Electronic Mailing List Subscription Form - Nutritions and Food Safety

Electronic Mailing List Sign-up Form_001

Electronic Mailing List Subscription Form - Nutritions and Food Safety

OMB: 0518-0036

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Electronic Mailing List Sign-up Form
How would you like to receive messages from the list?
[] Regular Subscription - you will receive each message as it is sent to the list.
[] Digest - receive all messages sent to the list combined into one file that is sent
one time each day.
Your full name:

E-mail address:

Job Title (be specific):

Employer (agency, Organization, company):

Mailing Address (street. city, state, ZIP code):. .

Telephone:

Persons that work with certain U.S. Department of Agriculture Food and Nutritio~
Service programs may join this list. Please describe how you are eligible to join this list:

According to the Paperwork Reduction Act of 1995. an agency may not conduct or sponsor, and a person is not
required to a collection of information unless it displays a valid OMB control number. The valid OMB control
number for this information collection is PARA#0518-0036. The time required to complete this information will
very based upon one’s relationship to the resource being submitted. It is estimated to take 1 minute to complete the
entire survey. This includes time for reviewing instruction, researching existing data sources, gathering and
maintaining the data needed, and completing and reviewing the collection information. If you need help with this
form, please contact us. E-Mail address: [email protected]’;).’~ "Telephone number: (301) 504-6047.


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