Information Collection

Hussc 2012

IC 202851 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⚠️ Notice: This information collection may be referencing outdated material.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
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

IC Title:

HUSSC 2012

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.