AMS-71 spreadsheet

INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. (D), (F), (H), (I), & (K) should be entered in items 17 & 18 of OMB-83-I. For cols. (E), (F), & (J), the averages of the totals shall be computed, as follows, & then entered on the OMB-83-1. (F) Total/Total = (E) Average (H) Total/(F) Total = (G) Average (K) Total/(I) Total = (J) Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.

TITLE OF INFORMATION COLLECTION DOCUMENT

OMB NO.

Local Food Directories and Survey

0581-New

DATE PREPARED

14 February, 2014

IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT

RECORDS

TOTAL

FORMS NO (S)

NO. OF

NO OF

TOTAL ANNUAL

TOTAL

NO. OF

ANNUAL

RECORD-

SECTION OF

DESCRIPTION

(If "none"

RESPONDENTS

RESPONSES

RESPONSES

HOURS

RECORD-

HOURS PER

KEEPING HOURS

REGS.

so state)

PER

(Col. D x E)

(Col. F x G)

KEEPERS

RECORD-

(Col. I x J)

RESPONDENT

KEEPER

(A)

(B)

(C)

(D)

(E)

(F)

(G)

(H)

(I)

(J)

(K)

7 USC 1621 - 1627

On-Farm Market Questionnaire

50,000

0.0200

1,000.00

0.16700

167.00

0.00

Community Supported Agriculture (CSA) Questionnaire

6,500

0.1538

1,000.00

0.16700

167.00

0.00

Food Hub Questionnaire

250

0.5000

125.00

0.16700

20.88

0.00

SUBTOTAL

2,125.00

354.87

0.00

0.00

TOTAL OF ALL PAGES

2,125.00

354.87

0.00

0.00

TOTAL - COLUMNS "F" AND "I" = OMB 831, 13 b; COLUMNS "G" AND "K" = OMB 831, 13c

2,125.00

355