Healthy Food Financing Initiative Questionnaire

Healthy Food Financing Initiative (HFFI)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1559-0040 can be found here:

Documents and Forms

Document Name Document Type
2011 FA Data Tables.xls Other-Supplemental Chart
Supplemental Questionnaire (clean version 12-16-10).docx Other-Questionnaire

Information Collection (IC) Details

IC Title:	Healthy Food Financing Initiative Questionnaire	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 12 CFR 1805

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Supplemental Chart			2011 FA Data Tables.xls		Yes	Yes	Fillable Fileable
Other-Questionnaire			Supplemental Questionnaire (clean version 12-16-10).docx		Yes	Yes	Fillable Fileable

Line of Business: Economic Development

Subfunction: Business and Industry Development

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 30	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	30	30
Annual IC Time Burden (Hours)	900	900
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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