Information Collection

Healthy Food Financing Initiative Questionnaire

IC 195232 under ICR 201011-1559-001 · OMB 1559-0040.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
2011 FA Data Tables.xls	Other-Supplemental Chart
Supplemental Questionnaire (clean version 12-16-10).docx	Other-Questionnaire

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.