Generic Clearance to Conduct Formative Research

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form FNS 779 Food and Nutrition Service (FNS) HealthierUS School Challenge Recognizing Excellence in Nutrition and Physical Activity	Form and Instruction	Modified	Available
Form FNS-854 Attendee Evaluation Form	Form	Modified	Available
Form FNS-817 Level 3 Event Feedback Form	Form	Modified	Available
Form FNS-816 Level 1 Event Feedback Form	Form	Modified	Available
Form FNS-811 User Response Card	Form	Modified	Available
Form FNS-808 Power Panther Costume Event Feedback Form	Form	Modified	Available
Form FNS-807 Power Panther Costume Request and Agreement Form Eat Smart. Play Hard	Form	Modified	Available
Form FNS-793 FNS Core Nutrition Message Feedback Form	Form and Instruction	Modified	Available
Form FNS-792 Golden Grocer Award Nomination Form	Form and Instruction	Modified	Available
Form FNS-791 Promising Practices Submission Form	Form and Instruction	Modified	Available
Form FNS-790 Hunger Champions Award Nomination Form	Form and Instruction	Modified	Available
Form FNS-781 Team Nutrition School Enrollment Form	Form and Instruction	Modified	Available
0524 OMB Change Justification Memo 8-29-14.docx	Supplementary Document	Uploaded 2014-08-29	Available
Change Memo for 0584-0524 FNS-854.pdf	Justification for No Material/Nonsubstantive Change	Uploaded 2013-08-15	Available
Signed Change Memo FNS-807.pdf	Justification for No Material/Nonsubstantive Change	Uploaded 2013-07-26	Available
Final Supporting Statement for Generic Clearance Package updated 4-17-2013 .docx	Supporting Statement A	Uploaded 2013-04-17	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
221144	NSLP Verification II - Business IC (IC 2 of 2)	Other-Attachment E - Rolling Assignment Procedure Logic Model	New
221130	NSLP Verification II - SLT IC (IC 1 of 2)	Other-Attachment A - Verification Letter_Simplified	New
220866	FDD Distribution Costs to District for USDA Foods	Other-FDD Survey Distribution Costs to District for USDA Foods	New
220055	Middle School Digital Nutrition (SLT)	Other-Attachment A_Consent Package for Teacher Focus Groups	New
220051	Middle School Digital Nutrition I/H	Other-Attachment B_Consent Package for Parent_Caregivers	New
219552	Team Nutrition Educational Technology Environmental Scan	Other- Attachment A_Consent Package for School Focus Groups	New
218204	Nutrition Education and Promotion Toolkit for Teens - Focus Group Testing	Other-Attachment B Parent & Guardian Consent Form for Student Pa	New
217486	Test Modified Communication Protocols to Reduce Household Nonresponse in NSLP/SBP Verification Process - SLT	Other-Attachment B - Reminder Letter Final 7.13.15	New
217074	Team Nutrition Educational Materials for Summer Meals - SLT (IC1 of 2)	Other-Attachment C Consent Package for Site Operators_Final	New
216855	Team Nutrition Educational Materials for Summer Meals - Individuals/Households (IC 2 of 2)	Other-Attachment A Active Consent Package for ParentsCaregivers_	New
216551	Team Nutrition Educational Materials for Summer Meals	Other-20150224 Attachment A Screener for ParentCaregivers - Engl	New
215913	Perform Research for Loving Support Campaign Update (Phase 1)	Other-Attachment A - WIC Peer Counselor In-Depth Interview Guide	New
214985	Yogurt Pilot Survey	Other-SY15 Yogurt Pilot Survey 2. 24. 15	New
213186	FDD Qualitative Food Survey	Other-USDA Foods Product Feedback Survey	New
208682	Request Approval to Perform Research for Team Nutrition Posters-Phase 2	Other-A_FNS Screener_Student Focus Groups	Unchanged
208496	HHFKA CACFP Focus Group (Business Provider Group: CCC, FDC & SO)	Other-Attachment A PRE-NOTIFICATION MESSAGE FOR CHILD CARE CENTE	Unchanged
208494	HHFKA CACFP State Agencies	Other-Attachment A1 Pre-Notification to SA	Unchanged
206548	Consumer Research for Nutrition Education and Promotion Activities	Form and Instruction	Modified	Food and Nutrition Service (FNS) HealthierUS School Challenge Recognizing Excellence in Nutrition and Physical Activity
206548	Consumer Research for Nutrition Education and Promotion Activities	Form	Modified	Attendee Evaluation Form
206548	Consumer Research for Nutrition Education and Promotion Activities	Form	Modified	Level 3 Event Feedback Form
206548	Consumer Research for Nutrition Education and Promotion Activities	Form	Modified	Level 1 Event Feedback Form
206548	Consumer Research for Nutrition Education and Promotion Activities	Form	Modified	User Response Card
206548	Consumer Research for Nutrition Education and Promotion Activities	Form	Modified	Power Panther Costume Event Feedback Form
206548	Consumer Research for Nutrition Education and Promotion Activities	Form	Modified	Power Panther Costume Request and Agreement Form Eat Smart. Play Hard
206548	Consumer Research for Nutrition Education and Promotion Activities	Form and Instruction	Modified	FNS Core Nutrition Message Feedback Form
206548	Consumer Research for Nutrition Education and Promotion Activities	Form and Instruction	Modified	Golden Grocer Award Nomination Form
206548	Consumer Research for Nutrition Education and Promotion Activities	Form and Instruction	Modified	Promising Practices Submission Form
206548	Consumer Research for Nutrition Education and Promotion Activities	Form and Instruction	Modified	Hunger Champions Award Nomination Form
206548	Consumer Research for Nutrition Education and Promotion Activities	Form and Instruction	Modified	Team Nutrition School Enrollment Form
206548	Consumer Research for Nutrition Education and Promotion Activities	Other-FNS 779-780 Screen Shots	Modified

ICR Details

OMB Control No: 0584-0524	ICR Reference No: 201407-0584-002
Status: Historical Active	Previous ICR Reference No: 201308-0584-004
Agency/Subagency: USDA/FNS	Agency Tracking No: Non substantive Revision to Combine 779 & 780
Title: Generic Clearance to Conduct Formative Research
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/02/2014
Retrieve Notice of Action (NOA)	Date Received in OIRA: 08/29/2014
Terms of Clearance: Previous terms continue: FNS will submit individual collections under this generic clearance to OMB. OMB will strive to provide feedback on the individual collections within ten working days, whenever possible. Standard incentive amount is remuneration is $40.00; requests for higher levels must be justified (e.g., very difficult recruitments), two-hour focus groups, etc.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2016	06/30/2016	06/30/2016
Responses	151,700	0	151,700
Time Burden (Hours)	58,405	0	58,405
Cost Burden (Dollars)	0	0	0

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Abstract: Information collection is necessary to obtain formative input on the development of nutrition education materials and related tools for population groups served by the U.S. Department of Agriculture

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Authorizing Statute(s): PL: Pub.L. 107 - 249 202-215 Name of Law: Emergency Food Assistance Act of 1983
   PL: Pub.L. 107 - 293 5 Name of Law: Agriculture and Consumer Protection Act of 1973
   PL: Pub.L. 108 - 269 17 Name of Law: Food Stamp Act of 1977
   PL: Pub.L. 109 - 85 17 Name of Law: Child Nutrition Act of 1966
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 75110	12/19/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 79	04/24/2013
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 18

table that charts list of burden

IC Title	Form No.	Form Name
Consumer Research for Nutrition Education and Promotion Activities	FNS-793, FNS-790, FNS-791, FNS-792, FNS-807, FNS-808, FNS-811, FNS-816, FNS-817, FNS 779, FNS-854, FNS-781	Team Nutrition School Enrollment Form ,   Hunger Champions Award Nomination Form ,   Promising Practices Submission Form ,   Golden Grocer Award Nomination Form ,   FNS Core Nutrition Message Feedback Form ,   Power Panther Costume Request and Agreement Form Eat Smart. Play Hard ,   Power Panther Costume Event Feedback Form ,   User Response Card ,   Level 1 Event Feedback Form ,   Level 3 Event Feedback Form ,   Attendee Evaluation Form ,   Food and Nutrition Service (FNS) HealthierUS School Challenge Recognizing Excellence in Nutrition and Physical Activity
FDD Distribution Costs to District for USDA Foods
FDD Qualitative Food Survey
HHFKA CACFP Focus Group (Business Provider Group: CCC, FDC & SO)
HHFKA CACFP State Agencies
Middle School Digital Nutrition (SLT)
Middle School Digital Nutrition I/H
NSLP Verification II - Business IC (IC 2 of 2)
NSLP Verification II - SLT IC (IC 1 of 2)
Nutrition Education and Promotion Toolkit for Teens - Focus Group Testing
Perform Research for Loving Support Campaign Update (Phase 1)
Request Approval to Perform Research for Team Nutrition Posters-Phase 2
Team Nutrition Educational Materials for Summer Meals
Team Nutrition Educational Materials for Summer Meals - Individuals/Households (IC 2 of 2)
Team Nutrition Educational Materials for Summer Meals - SLT (IC1 of 2)
Team Nutrition Educational Technology Environmental Scan
Test Modified Communication Protocols to Reduce Household Nonresponse in NSLP/SBP Verification Process - SLT
Yogurt Pilot Survey

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	151,700	151,700	0	0	0	0
Annual Time Burden (Hours)	58,405	58,405	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The Agency requests an increase in the currently approved hours from 33,016 to 58,405 and an increase in the number of respondents from 79,000 to 151,700 over the three-year extension. We based the increase in burden hours and respondents on past use and projections of future needs. The Agency believes that the number of hours and respondents requested will be sufficient to meet the needs of data collection events over the next three years.

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Annual Cost to Federal Government: $400,000

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 08/29/2014

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