MyPlate

Generic Clearance to Conduct Formative Research

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Attachment A - Teacher Letter_Response Form_Consent Form_march13r.doc Other-Attachment A - Teacher Letter_
Attachment C - Food Service Staff Letter_Response Form_Consent Form_March_13r.doc Other-Attachment C: State Agency (FS
Attachment F - Moderator's Guide for Teachers_Grades 1-6_March_13r.docx Other-Attachment F - Moderator's Gui
Attachment G - Educator Journal for Teachers_Grades 1-6_March13r.docx Other-Attachment G - Educator Journa
Attachment H - Moderator's Guide for Food Service Staff_march13r.docx Other-Attachment H - Moderator's Gui
MyPlate OMB Proposal_march22.docx MyPlate Change Jusitification Memo IC Document

Information Collection (IC) Details

IC Title:	MyPlate	Agency IC Tracking Number:	State Agency

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Electronic Capability
Other-Attachment A - Teacher Letter_Response Form_Consent Form	Attachment A - Teacher Letter_Response Form_Consent Form_march13r.doc	No	Paper Only
Other-Attachment C: State Agency (FS Staff) Consent Forms	Attachment C - Food Service Staff Letter_Response Form_Consent Form_March_13r.doc	No	Paper Only
Other-Attachment F - Moderator's Guide for Teachers_Grades 1-6	Attachment F - Moderator's Guide for Teachers_Grades 1-6_March_13r.docx	No	Paper Only
Other-Attachment G - Educator Journal for Teachers_Grades 1-6	Attachment G - Educator Journal for Teachers_Grades 1-6_March13r.docx	No	Paper Only
Other-Attachment H - Moderator's Guide for Food Service Staff	Attachment H - Moderator's Guide for Food Service Staff_march13r.docx	No	Paper Only

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 16	Number of Respondents for Small Entity: 2

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	16	16
Annual IC Time Burden (Hours)	10	10
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
MyPlate Change Jusitification Memo	MyPlate OMB Proposal_march22.docx	04/05/2012

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