Generic Clearance to Conduct Formative Research

Forms and Documents

Document Name	Status
What You Can Do for School Wellness Communication Tools Testing Form and Instruction	New
change justification memo 8-2-2010.docx Justification for No Material/Nonsubstantive Change	2010-08-04
HUSSC change justification memo 7-8-2010.docx Justification for No Material/Nonsubstantive Change	2010-07-12
Dietary Guidelines Jan 05.pdf Supplementary Document	2006-12-27
Supporting Statement 3-30-2010.doc Supporting Statement A	2010-03-30

IC Document Collections

IC ID	Document Title	Status
202851	HUSSC 2012 Other-FNS-780 2012 HUSSC Bronze-Silver Application	New
202026	MyPlate Parent/Student REV Other-Attachment B - Parent Letter_Response Form_Consent Form fo	New
201535	MyPlate Other-Attachment A - Teacher Letter_Response Form_Consent Form	New
200916	Zero Income (I/H) Other-Attachment A1 - Interview Guide - English	New
200681	Team Nutrtition Curriculum Messages for 5 & 6th Grades (I/H) Other-Attachment H	New
200504	Team Nutrition Curriculum Messages for 5 & 6th Grades (SA) Other-Teacher Letter Teacher Respnse Teacher Consent	New
200310	Zero Income (SA) Other-Recruitment Letter to states	New
198917	Team Nutrition Curriculum (State Agencies: Teachers & Foodservice Staff) Other-Protocol for Administration of Student Pretest	New
198840	Team Nutrition Curriculum (I/H) Other-Student Pretest	New
198156	What You Can Do for School Wellness Communication Tools Testing Form and Instruction	New
195938	Team Nutrition Gardens Formative Research Other-Focus Group Moderator Guide	New
195334	Healthy School Environment Other-Security Agreement - Adults	New
194845	Core Nutrition Messages - Revised Other-Triad Screening questionnaire Low-Income Mothers	New
192056	Consumer Research for Nutrition Education and Promotion Activities Other-Script	Unchanged

ICR Details

OMB Control No: 0584-0524	ICR Reference No: 201008-0584-001
Status: Historical Active	Previous ICR Reference No: 201007-0584-001
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 without change	Conclusion Date: 08/13/2010
	Date Received in OIRA: 08/11/2010
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2013	04/30/2013	04/30/2013
Responses	57,000	0	38,000
Time Burden (Hours)	21,016	0	14,000
Cost Burden (Dollars)	0	0	0

---

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

---

Authorizing Statute(s): 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
   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
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 55804	10/29/2009
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 55	03/23/2010
Did the Agency receive public comments on this ICR? Yes

---

Number of Information Collection (IC) in this ICR: 14

IC Title	Form No.	Form Name
Consumer Research for Nutrition Education and Promotion Activities	FNS 780, FNS 816, FNS 779, FNS 817, FNS 804, FNS 805, FNS 813, FNS 807, FNS 808, FNS 809, FNS 810, FNS 811, FNS 792, FNS 812, FNS 803, FNS-793, FNS-779, FNS-780, FNS-781, FNS-791, FNS-790	Golden Grocer Award Nomination Form ,   User Response Form ,   Healthy Lifestyle User Response ,   Kids User Response ,   Power Partner Commitment ,   Team Nutrition School Enrollment Form ,   Gold Application for Recognizing Excellence in Nutrition and Physical Activity ,   Bronze/Silver Recognizing Excellence in Nutrition and Physical Activity ,   Hunger Champions Nomination Form ,   Promising Practices Submission Form ,   FNS Core Nutrition Messags Feedback Form ,   Power Panther Request and Agreement ,   Event Feedback (Power Panther) ,   Promote and Support Breastfeeding Feedback ,   Promote Fruits and Vegetables in Your Workplace ,   User Response Card ,   Activity Kit User Response Form ,   Gold/Gold Award of Distinction Application ,   Bronze/Silver Award Application ,   Level I Feedback ,   Level III Feedback Form
Team Nutrition Gardens Formative Research
Team Nutrition Curriculum (State Agencies: Teachers & Foodservice Staff)
Zero Income (SA)
MyPlate
Core Nutrition Messages - Revised
What You Can Do for School Wellness Communication Tools Testing	NA, NA, NA, NA, NA, NA, NA, NA, NA, NA, NA, NA, NA, NA	NA ,   NA ,   NA ,   NA ,   NA ,   NA ,   NA ,   NA ,   NA ,   NA ,   NA ,   NA ,   NA ,   NA
Team Nutrition Curriculum (I/H)
HUSSC 2012
Team Nutrition Curriculum Messages for 5 & 6th Grades (SA)
Team Nutrtition Curriculum Messages for 5 & 6th Grades (I/H)
Healthy School Environment
MyPlate Parent/Student REV
Zero Income (I/H)

---

ICR Summary 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	57,000	38,000	0	19,000	0	0
Annual Time Burden (Hours)	21,016	14,000	0	7,016	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

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

Burden Reduction Due to:

Short Statement: The inclusion of the Healthier US Schools Challenge to the First Lady’s “Let’s Move” campaign necessitates an increased focus on that area and the program wishes to modify the forms and add burden hours to that project. The HUSSC initiative motivates and facilitates improvements in nutrition and physical activity in schools by collecting and sharing best practices and showcasing schools that have made positive steps in advancing implementation of wellness policies and the 2005 Dietary Guidelines for Americans. HUSSC supports the congressional mandate regarding school wellness including development and implementation of such policies. Additionally, other projects that will support the administration’s anti-obesity messaging and partnerships have come to light that will need 19,000 additional responses and 7,016 additional burden hours which will increase FNS burden inventory to 57,000 responses and 21,016 burden hours. The Administration’s goal of ending childhood hunger by 2015 and childhood obesity within a generation has intensified efforts to provide stakeholders with more comprehensive and timely information about successful and effective nutrition education and outreach methods, new or revised policies or changes in legislation, as well as ways to make it easier for schools to apply for (HUSSC) status. These information collection requests support these national goals of eliminating hunger and childhood obesity.

---

Annual Cost to Federal Government: $158,333

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]? No

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)? No

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  No

---

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: 08/11/2010

---