Information Collection

MyPlate

IC 201535 under ICR 201008-0584-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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
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

IC Title:

MyPlate

Agency IC Tracking Number:

State Agency

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.