Hussc 2012

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⚠️ Notice: This information collection may be referencing outdated material.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
rev062712 2012 HUSSC Bronze-Silver Application.doc teamnutrition.usda.gov/healthierUS/index.html Other-FNS-780 2012 HUSSC Bronze-Silv
rev062712 2012 HUSSC Gold-Gold Award of Distinction Application.doc teamnutrition.usda.gov/healthierUS/index.html Other-FNS 779 - 2012 HUSSC Gold-Gold
Attachment C - TN Enrollment Form.doc www.teamnutrition.usda.gov/healthierus/index.html Other-TN Enrollment Form
rev062612 HUSSC Justification Memo 6-25-12.doc HUSSC Generic Clearance Justification IC Document

Information Collection (IC) Details

IC Title:	HUSSC 2012	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-FNS-780 2012 HUSSC Bronze-Silver Application	rev062712 2012 HUSSC Bronze-Silver Application.doc	http://teamnutrition.usda.gov/healthierUS/index.html	Yes	Yes	Paper Only
Other-FNS 779 - 2012 HUSSC Gold-Gold Award of Distinction Application Award of Distinction Application 05222012	rev062712 2012 HUSSC Gold-Gold Award of Distinction Application.doc	http://teamnutrition.usda.gov/healthierUS/index.html	Yes	Yes	Paper Only
Other-TN Enrollment Form	Attachment C - TN Enrollment Form.doc	www.teamnutrition.usda.gov/healthierus/index.html	Yes	Yes	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,000	Number of Respondents for Small Entity: 300

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3,000	3,000
Annual IC Time Burden (Hours)	2,166	2,166
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
HUSSC Generic Clearance Justification	rev062612 HUSSC Justification Memo 6-25-12.doc	06/26/2012

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