Information Collection

Healthy Food Financing Initiative Questionnaire

IC 195232 under ICR 201203-1559-001 · OMB 1559-0040.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Copy of FA Data Tables (2).xls	Other-Supplemental Chart
Persistent Poverty Determination Final.doc	Other-Commitment
CDFI 0001 HEALTHY FOOD FINANCING INITIATIVE -SUPPLEMENTAL QUESTION HFFI-FA Supplemental Questionnaire PRA 112811.doc	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Supplemental Chart			Copy of FA Data Tables (2).xls	Yes	Yes	Fillable Fileable
Form and Instruction	CDFI 0001	HEALTHY FOOD FINANCING INITIATIVE -SUPPLEMENTAL QUESTIONNAIRE	HFFI-FA Supplemental Questionnaire PRA 112811.doc	Yes	Yes	Fillable Fileable
Other-Commitment			Persistent Poverty Determination Final.doc	Yes	No	Fillable Fileable

Line of Business: Economic Development

Subfunction: Business and Industry Development

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 20

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	Previously Approved
Annual Number of Responses for this IC	20	20
Annual IC Time Burden (Hours)	600	600
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.