Information Collection

CNPP Qualitative Nutrition Quiz Research

IC 242753 under ICR 202001-0503-001 · OMB 0503-0024.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0503-0024 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
FNS Attachment A-1 USDA Quiz Screener7-22-2020.docx	Other-Screener
FNS Handout 1 StartSimpleQuizFinal.pdf	Other-Handout
A-11 USDA FNS Clearance Customer Service Template.docx FNS A-11 CX Generic Clearance Template	IC Document
FNS Attachment B-1 Confidentiality Agreement.docx FNS Attachment B	IC Document
FNS Attachment C-1 USDA Quiz Focus Group Guide.docx FNS Attachment C Focus Group Guide	IC Document
FNS Attachment D-1 Consent Form.docx FNS Attachment D Consent Form	IC Document
FNS Attachment E-1 Focus Group Confirmation Form.docx FNS Attachment E Focus Group Confirmation Form	IC Document
Webpage 1 MyPlate.Gov_QuizResultsPage.pdf Webpage My Plate Quiz Result Page	IC Document

IC Title:

CNPP Qualitative Nutrition Quiz Research

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-Screener			FNS Attachment A-1 USDA Quiz Screener7-22-2020.docx		Yes	Yes	Fillable Fileable
Other-Handout			FNS Handout 1 StartSimpleQuizFinal.pdf		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 320

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	320	320
Annual IC Time Burden (Hours)	193	193
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
FNS A-11 CX Generic Clearance Template	A-11 USDA FNS Clearance Customer Service Template.docx	07/22/2020
FNS Attachment B	FNS Attachment B-1 Confidentiality Agreement.docx	07/22/2020
FNS Attachment C Focus Group Guide	FNS Attachment C-1 USDA Quiz Focus Group Guide.docx	07/22/2020
FNS Attachment D Consent Form	FNS Attachment D-1 Consent Form.docx	07/22/2020
FNS Attachment E Focus Group Confirmation Form	FNS Attachment E-1 Focus Group Confirmation Form.docx	07/22/2020
Webpage My Plate Quiz Result Page	Webpage 1 MyPlate.Gov_QuizResultsPage.pdf	07/22/2020

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