Electronic Mailing List Subscription Form Burden Data Worksheet

INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)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.

Electronic Mailing List Subscription Form - Nutritions and Food Safety

0518-0036

DATE PREPARED

September 15 2015\

IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT

ANNUAL BURDEN

REPORTS

RECORDS

TOTAL

FORMS NO (S)

NO. OF

NO OF

TOTAL ANNUAL

HOURS

TOTAL

NO. OF

ANNUAL

RECORD-

SECTION OF

DESCRIPTION

(If "none"

RESPONDENTS

RESPONSES

RESPONSES

PER

HOURS

RECORD-

HOURS PER

KEEPING HOURS

REGS.

so state)

PER

(Col. D x E)

RESPONSE

(Col. F x G)

KEEPERS

RECORD-

(Col. I x J)

RESPONDENT

KEEPER

(A)

(B)

(C)

(D)

(E)

(F)

(G)

(H)

(I)

(J)

(K)

FNIC Nutrition Talk

None

200

1.0000

200.00

0.0170

3.40

Mealtalk

None

300

1.0000

300.00

0.0170

5.10

Successtalk

None

200

1.0000

200.00

0.0170

3.40

Summertalk

None

100

1.0000

100.00

0.0170

1.70

Team Nutrition

None

200

1.0000

200.00

0.0154

3.08

Electronic Mailing List Sign Up Form

SUBTOTAL

1,000.00

1,000.00

16.68