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.
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TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
| Dairy Donation and Distribution Plan, Eligible Distributor Certification Form, Reimbursement Claim Form, and Report of Receipts and Utilization |
0581-0327 |
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|
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| DATE PREPARED |
|
| March 9, 2022 |
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
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REPORTS |
RECORDS |
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TOTAL |
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|
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) |
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RESPONDENT |
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|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
| 7 CFR 1147.102 |
Dairy Donation and Distribution Plan |
DDP-P |
150 |
2 |
300.00 |
1.0000 |
300 |
|
|
0.00 |
| 7 CFR 1147.102 |
Eligible Distributor Certification Form |
DDP-C |
300 |
1 |
300.00 |
0.2500 |
75 |
|
|
0.00 |
| 7 CFR 1147.106 |
Reimbursement Claim Form |
DDP-RC |
150 |
8 |
1,200.00 |
2.0000 |
2,400 |
|
|
0.00 |
| 7 CFR 1147.1 |
Report of Receipts and Utilization (currently approved under OMB-0581-0032) |
HR-EZ |
15 |
1 |
15.00 |
1.0000 |
15 |
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0.00 |
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0.00 |
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TOTAL |
|
615.00 |
12.00 |
1,815.00 |
4.25 |
2,790.00 |
|
|
0.00 |