Information Collection

USDA Foods Household Fact Sheets Feedback Survey

IC 229571 under ICR 201605-0584-004 · OMB 0584-0611.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0611 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Fact Sheet Survey Questions 122617.docx www.wufoo.com	Other-USDA Foods Household Fact Shee
FNS Fast Track Clearance Submission - Household Fact Sheets Feedback Survey.docx Fast Track Clearance Request - USDA Foods Household Fact Sheets Feedback Survey	IC Document

IC Title:

USDA Foods Household Fact Sheets Feedback Survey

Agency IC Tracking Number:

IC Status: New

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
Other-USDA Foods Household Fact Sheets Feedback Survey			Fact Sheet Survey Questions 122617.docx	www.wufoo.com	Yes	Yes	Fillable Fileable

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3,162

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3,162	3,162
Annual IC Time Burden (Hours)	458	458
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Fast Track Clearance Request - USDA Foods Household Fact Sheets Feedback Survey	FNS Fast Track Clearance Submission - Household Fact Sheets Feedback Survey.docx	12/26/2017

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