Generic Clearance to Conduct Formative Research

Forms and Documents

Document Name	Status
Form FNS-781 Consumer Research for Nutrition Education and Promotion Activities Form and Instruction	Unchanged
Change Request - Memo_to_OMB_requesting_change_to_original_approval_060716.docx Justification for No Material/Nonsubstantive Change	2016-06-07
0524 OMB Change Justification Memo 8-29-14.docx Supplementary Document	2014-08-29
Change Memo for 0584-0524 FNS-854.pdf Justification for No Material/Nonsubstantive Change	2013-08-15
Signed Change Memo FNS-807.pdf Justification for No Material/Nonsubstantive Change	2013-07-26
Final Supporting Statement for Generic Clearance Package updated 4-17-2013 .docx Supporting Statement A	2013-04-17

IC Document Collections

IC ID	Document Title	Status
221144	NSLP Verification II - Business IC (IC 2 of 2) Other-Attachment E - Rolling Assignment Procedure Logic Model	Unchanged
221130	NSLP Verification II - SLT IC (IC 1 of 2) Other-Attachment A - Verification Letter_Simplified	Unchanged
220866	FDD Distribution Costs to District for USDA Foods Other-FDD Survey Distribution Costs to District for USDA Foods	Unchanged
220055	Middle School Digital Nutrition (SLT) Other-Attachment A_Consent Package for Teacher Focus Groups	Unchanged
220051	Middle School Digital Nutrition I/H Other-Attachment B_Consent Package for Parent_Caregivers	Unchanged
219552	Team Nutrition Educational Technology Environmental Scan Other- Attachment A_Consent Package for School Focus Groups	Unchanged
218204	Nutrition Education and Promotion Toolkit for Teens - Focus Group Testing Other-Attachment B Parent & Guardian Consent Form for Student Pa	Unchanged
217486	Test Modified Communication Protocols to Reduce Household Nonresponse in NSLP/SBP Verification Process - SLT Other-Attachment H - LEA Recruitment Letter Final 7.13.15	Unchanged
217074	Team Nutrition Educational Materials for Summer Meals - SLT (IC1 of 2) Other-Attachment C Consent Package for Site Operators_Final	Unchanged
216855	Team Nutrition Educational Materials for Summer Meals - Individuals/Households (IC 2 of 2) Other-Attachment A Active Consent Package for ParentsCaregivers_	Unchanged
216551	Team Nutrition Educational Materials for Summer Meals Other-20150224 Attachment A Screener for ParentCaregivers - Engl	Unchanged
215913	Perform Research for Loving Support Campaign Update (Phase 1) Other-Attachment A - WIC Peer Counselor In-Depth Interview Guide	Unchanged
214985	Yogurt Pilot Survey Other-SY15 Yogurt Pilot Survey 2. 24. 15	Unchanged
213186	FDD Qualitative Food Survey Other-USDA Foods Product Feedback Survey	Unchanged
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	Unchanged

ICR Details

OMB Control No: 0584-0524	ICR Reference No: 201606-0584-004
Status: Historical Active	Previous ICR Reference No: 201407-0584-002
Agency/Subagency: USDA/FNS	Agency Tracking No:
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: 06/16/2016
	Date Received in OIRA: 06/15/2016
Terms of Clearance:

	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

IC Title	Form No.	Form Name
Consumer Research for Nutrition Education and Promotion Activities	FNS-854, FNS-781, FNS-790, FNS-791, FNS-792, FNS-793, FNS-807, FNS-808, FNS-811, FNS-816, FNS-817, FNS 779	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
Yogurt Pilot Survey
FDD Qualitative Food Survey
HHFKA CACFP State Agencies
Test Modified Communication Protocols to Reduce Household Nonresponse in NSLP/SBP Verification Process - SLT
NSLP Verification II - Business IC (IC 2 of 2)
Team Nutrition Educational Technology Environmental Scan
NSLP Verification II - SLT IC (IC 1 of 2)
Team Nutrition Educational Materials for Summer Meals - SLT (IC1 of 2)
Request Approval to Perform Research for Team Nutrition Posters-Phase 2
HHFKA CACFP Focus Group (Business Provider Group: CCC, FDC & SO)
Team Nutrition Educational Materials for Summer Meals
FDD Distribution Costs to District for USDA Foods
Middle School Digital Nutrition I/H
Perform Research for Loving Support Campaign Update (Phase 1)
Nutrition Education and Promotion Toolkit for Teens - Focus Group Testing
Middle School Digital Nutrition (SLT)
Team Nutrition Educational Materials for Summer Meals - Individuals/Households (IC 2 of 2)

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ICR Summary 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: 06/15/2016

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