Information Collection

Healthy Food Financing Initiative Questionnaire

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

Documents and Forms

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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Healthy Food Financing Initiative Questionnaire	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:

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 %

	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

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.