DGA Focus Group w/OMB Recommendations

OMB# 0584-0523

Expiration Date: 12/31/2012

Public reporting burden for this collection of information is estimated to average 1 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: U.S. Department of Agriculture, Food and Nutrition Services, Office of Research and Analysis, 3101 Park Center Drive, Room 1014, Alexandria, VA 22302 ATTN: PRA (0584-0523*). Do not return the completed form to this address.

Appendix C

Confidentiality Agreement

Focus Groups

You have agreed to participate in a focus group of 8 to 10 people to talk about nutrition topics. This research is sponsored by the Center for Nutrition Policy and Promotion. Our contractor is conducting the focus groups and will use the feedback to develop nutrition information for consumers.

Your time is valuable and we appreciate your willingness to share your thoughts. All information shared during the focus groups is confidential to the extent of the law. No individual will be identified in reports or documents resulting from this discussion. By participating in this focus group, you also agree not to share any information provided during the discussion.

Thank you for your time.

Signature of Participant Date

Name of Participant (please print)