Information Collection

Consumer Research for Nutrition Education and Promotion Activities

IC 192056 under ICR 201207-0584-007 · 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⚠️ Notice: This information collection may be referencing outdated material.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
Form FNS-781 Consumer Research for Nutrition Education and Promotion Activities	Form and Instruction
Administrators Screener USDA Food Program.doc	Other-Screening Guide
CNP Benchmark Screen Shots USDA Food Program.doc www.globaltestmarket.com/survey/s.phtml?sn=151310&demo=1&lang=E&secid=daecaa	Other-Questionnaire
CNP Screen Shots USDA Food Program.doc www.globaltestmarket.com/survey/s.phtml?sn=151310&demo=1&lang=E&secid=daecaa	Other-Questionnaire
CNP Screener USDA Food Program.doc	Other-Screener Guide
Confidentiality_Agreements_USDA Food Program.doc	Other-Confidentiality Agreements
IDI_Script_USDA Food Program.doc	Other-Script
Parents_Guides_USDA Food Program.doc	Other-Parent Guide
Partner_Screener_USDA Food Program.doc	Other-Partner Screener
Recruitment_Screeners_USDA Food Program.doc	Other-Recruitment Screener
Teacher Benchmark Q USDA Food Program.doc	Other-Teacher Benchmark
Teacher Benchmark Screen Shots USDA Foods.doc mrd.saynation.com/MRDSAYNATION/QSurvey/?UID=panelist&SID=S195377173683131&TEST=1	Other-Teacher Benchmark
Teacher Screener - USDA Food Program.doc	Other-Teacher Screener
Teacher_Guide_USDA Food Program.doc	Other-Teacher Guide
FNS-781 Team Nutrition School Enrollment Form FNS-781 - Team Nutrition.pdf healthymeals.nal.usda.gov/hsmrs/hussc	Form and Instruction
FNS-779 Gold Application for Recognizing Excellence in Nutrition FNS-779.pdf	Form and Instruction
FNS-780 Bronze/Silver Recognizing Excellence in Nutrition and Ph FNS-780.pdf	Form and Instruction
FNS-790 Hunger Champions Nomination Form FNS-790.pdf www.fns.usda.gov//snap/outreach/default.htm	Form and Instruction
FNS-791 Promising Practices Submission Form FNS-791.pdf www.fns.usda.gov/snap/outreach/default.htm	Form and Instruction
FNS-793 FNS Core Nutrition Messags Feedback Form FNS-793.pdf	Form and Instruction
FNS 792 Golden Grocer Award Nomination Form FNS-792.pdf www.fns.usda.gov/snap/outreach/default.htm	Form and Instruction
FNS 803 User Response Form FNS 803 Wed Site User Response Form (ESPH Educators).doc [email protected]	Form
FNS 804 Healthy Lifestyle User Response FNS 804 Healthy Lifestyle Web User Response Form.doc [email protected]	Form
FNS 805 Kids User Response FNS-805 Kids Web Site User Response Form.doc [email protected]	Form
FNS 813 Power Partner Commitment FNS-813 Power Partner Commitment Form.doc [email protected]	Form
FNS 807 Power Panther Request and Agreement FNS-807 Power Panther Request and Agreement Form.doc	Form
FNS 808 Event Feedback (Power Panther) FNS 808- Event Feedback Form (Power Panther).doc [email protected]	Form
FNS 809 Promote and Support Breastfeeding Feedback FNS 809 Promote and support breasfeeding feedback form.doc www.fns.usda.gov/ora/SNAP/TakeAction/TakeAction.htm	Form
FNS 810 Promote Fruits and Vegetables in Your Workplace FNS 810 Promote Fruits and Vegetables in Your Workplace & Community.doc www.fns.usda.gov/ora/SNAP/TakeAction/TakeAction.htm	Form
FNS 811 User Response Card FNS -811 User Response Card-LYFFF.doc www.fns.usda.gov/snap/nutrition_education/	Form
FNS 812 Activity Kit User Response Form FNS-812 ACTIVITY KIT USER RESPONSE FORM(ESLS).doc www.fns.usda.gov/snap/nutrition_education/	Form
FNS 779 Gold/Gold Award of Distinction Application 779.pdf	Form and Instruction
FNS 780 Bronze/Silver Award Application FNS-780.pdf	Form and Instruction
FNS 816 Level I Feedback FNS-816.pdf www.fns.usda.gov/fns/outreach.htm.	Form
FNS 817 Level III Feedback Form FNS-817.pdf www.fns.usda.gov/fns/outreach.htm.	Form
Reminder_Email_Benchmark_USDA Food Program.doc Reminder Email	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Consumer Research for Nutrition Education and Promotion Activities

Agency IC Tracking Number:

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

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
Form and Instruction	FNS-781	Team Nutrition School Enrollment Form	FNS-781 - Team Nutrition.pdf	http://healthymeals.nal.usda.gov/hsmrs/hussc	Yes	Yes	Fillable Fileable Signable
Form and Instruction	FNS-779	Gold Application for Recognizing Excellence in Nutrition and Physical Activity	FNS-779.pdf		No		Fillable Printable
Form and Instruction	FNS-780	Bronze/Silver Recognizing Excellence in Nutrition and Physical Activity	FNS-780.pdf		No		Fillable Printable
Form and Instruction	FNS-790	Hunger Champions Nomination Form	FNS-790.pdf	http://www.fns.usda.gov//snap/outreach/default.htm	Yes	Yes	Fillable Fileable
Form and Instruction	FNS-791	Promising Practices Submission Form	FNS-791.pdf	http://www.fns.usda.gov/snap/outreach/default.htm	Yes	Yes	Fillable Fileable
Form and Instruction	FNS-793	FNS Core Nutrition Messags Feedback Form	FNS-793.pdf		No		Fillable Printable
Other-Screening Guide			Administrators Screener USDA Food Program.doc		No		Paper Only
Other-Questionnaire			CNP Benchmark Screen Shots USDA Food Program.doc	http://www.globaltestmarket.com/survey/s.phtml?sn=151310&demo=1&lang=E&secid=daecaa	Yes	Yes	Fillable Fileable Signable
Other-Questionnaire			CNP Screen Shots USDA Food Program.doc	http://www.globaltestmarket.com/survey/s.phtml?sn=151310&demo=1&lang=E&secid=daecaa	Yes	Yes	Fillable Fileable Signable
Other-Screener Guide			CNP Screener USDA Food Program.doc		No		Paper Only
Other-Confidentiality Agreements			Confidentiality_Agreements_USDA Food Program.doc		No		Paper Only
Other-Script			IDI_Script_USDA Food Program.doc		No		Paper Only
Other-Parent Guide			Parents_Guides_USDA Food Program.doc		No		Paper Only
Other-Partner Screener			Partner_Screener_USDA Food Program.doc		No		Paper Only
Other-Recruitment Screener			Recruitment_Screeners_USDA Food Program.doc		No		Paper Only
Other-Teacher Benchmark			Teacher Benchmark Q USDA Food Program.doc		No		Paper Only
Other-Teacher Benchmark			Teacher Benchmark Screen Shots USDA Foods.doc	http://mrd.saynation.com/MRDSAYNATION/QSurvey/?UID=panelist&SID=S195377173683131&TEST=1	Yes	Yes	Fillable Fileable Signable
Other-Teacher Screener			Teacher Screener - USDA Food Program.doc		No		Paper Only
Other-Teacher Guide			Teacher_Guide_USDA Food Program.doc		No		Paper Only
Form and Instruction	FNS 792	Golden Grocer Award Nomination Form	FNS-792.pdf	http://www.fns.usda.gov/snap/outreach/default.htm	Yes	Yes	Fillable Fileable Signable
Form	FNS 803	User Response Form	FNS 803 Wed Site User Response Form (ESPH Educators).doc	[email protected]	Yes	Yes	Fillable Fileable Signable
Form	FNS 804	Healthy Lifestyle User Response	FNS 804 Healthy Lifestyle Web User Response Form.doc	[email protected]	Yes	Yes	Fillable Fileable Signable
Form	FNS 805	Kids User Response	FNS-805 Kids Web Site User Response Form.doc	[email protected]	Yes	Yes	Fillable Fileable Signable
Form	FNS 813	Power Partner Commitment	FNS-813 Power Partner Commitment Form.doc	[email protected]	Yes	Yes	Fillable Fileable Signable
Form	FNS 807	Power Panther Request and Agreement	FNS-807 Power Panther Request and Agreement Form.doc		No		Fillable Fileable
Form	FNS 808	Event Feedback (Power Panther)	FNS 808- Event Feedback Form (Power Panther).doc	[email protected]	Yes	Yes	Fillable Printable
Form	FNS 809	Promote and Support Breastfeeding Feedback	FNS 809 Promote and support breasfeeding feedback form.doc	http://www.fns.usda.gov/ora/SNAP/TakeAction/TakeAction.htm	Yes	Yes	Fillable Fileable Signable
Form	FNS 810	Promote Fruits and Vegetables in Your Workplace	FNS 810 Promote Fruits and Vegetables in Your Workplace & Community.doc	http://www.fns.usda.gov/ora/SNAP/TakeAction/TakeAction.htm	Yes	Yes	Fillable Printable
Form	FNS 811	User Response Card	FNS -811 User Response Card-LYFFF.doc	http://www.fns.usda.gov/snap/nutrition_education/	Yes	Yes	Fillable Printable
Form	FNS 812	Activity Kit User Response Form	FNS-812 ACTIVITY KIT USER RESPONSE FORM(ESLS).doc	http://www.fns.usda.gov/snap/nutrition_education/	Yes	Yes	Fillable Fileable Signable
Form and Instruction	FNS 779	Gold/Gold Award of Distinction Application	779.pdf		No		Paper Only
Form and Instruction	FNS 780	Bronze/Silver Award Application	FNS-780.pdf		No		Paper Only
Form	FNS 816	Level I Feedback	FNS-816.pdf	http://www.fns.usda.gov/fns/outreach.htm.	Yes	Yes	Fillable Fileable Signable
Form	FNS 817	Level III Feedback Form	FNS-817.pdf	http://www.fns.usda.gov/fns/outreach.htm.	Yes	Yes	Fillable Fileable Signable

Federal Enterprise Architecture Business Reference Module

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 10,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 2 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	38,000	38,000
Annual IC Time Burden (Hours)	14,000	14,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Reminder Email	Reminder_Email_Benchmark_USDA Food Program.doc	03/04/2010

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