amendmentnewcollaborators

To:

Amendment for New
Collaborators
USDA ERS
OMB No. 0536-XXXX
Exp. Date:

Jay Variyam
Director, Food Economics Division, USDA

From: [Name]
[Senior Official Title]
[Institution]
Subject: Amendment of the Project agreement between the Economic Research Service, USDA (ERS)
and [Institution name] regarding the designation of [institution] staff as agents to perform economic
research using FoodAPS data.
I hereby request that the ERS-[institution] Project Agreement be amended to have the following added
as a project participant:
Name:
Title:
Phone number:
Email Address:
The added participant will complete all of the requirements stated in the Security section of the
agreement.
Except as herein amended, all other terms and conditions of the agreement will remain in full force and
effect.

[Title/Institution]
[Senior Official name]
Signature

Date

Director, Food Economics Division, USDA
Jay Variyam
Signature

Date

The information you provide will be used for statistical purposes only. Your responses will be kept confidential and any person who willfully
discloses ANY identifiable information about you or your operation is subject to a jail term, a fine, or both. This survey is conducted in
accordance with the Confidential Information Protection provisions of Title V, Subtitle A, Public Law 107-347 and other applicable Federal laws.
Response is voluntary.
According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a
collection of information unless it displays a valid OMB control number. The valid OMB number is 0536-xxxx. The time required to complete
this information collection is estimated to average 60 minutes per project (optional form - estimated 10% of projects), including the time for
reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the
collection of information