Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Consumer Research for Nutrition Education and Promotion Activities Unchanged 38000 14000 0 Form and Instruction FNS-781 Team Nutrition School Enrollment Form
Form and Instruction FNS-779 Gold Application for Recognizing Excellence in Nutrition and Physical Activity
Form and Instruction FNS-780 Bronze/Silver Recognizing Excellence in Nutrition and Physical Activity
Form and Instruction FNS-790 Hunger Champions Nomination Form
Form and Instruction FNS-791 Promising Practices Submission Form
Form and Instruction FNS-793 FNS Core Nutrition Messags Feedback Form
Other-Screening Guide
Other-Questionnaire
Other-Questionnaire
Other-Screener Guide
Other-Confidentiality Agreements
Other-Script
Other-Parent Guide
Other-Partner Screener
Other-Recruitment Screener
Other-Teacher Benchmark
Other-Teacher Benchmark
Other-Teacher Screener
Other-Teacher Guide
Form and Instruction FNS 792 Golden Grocer Award Nomination Form
Form FNS 803 User Response Form
Form FNS 804 Healthy Lifestyle User Response
Form FNS 805 Kids User Response
Form FNS 813 Power Partner Commitment
Form FNS 807 Power Panther Request and Agreement
Form FNS 808 Event Feedback (Power Panther)
Form FNS 809 Promote and Support Breastfeeding Feedback
Form FNS 810 Promote Fruits and Vegetables in Your Workplace
Form FNS 811 User Response Card
Form FNS 812 Activity Kit User Response Form
Form and Instruction FNS 779 Gold/Gold Award of Distinction Application
Form and Instruction FNS 780 Bronze/Silver Award Application
Form FNS 816 Level I Feedback
Form FNS 817 Level III Feedback Form
Core Nutrition Messages - Revised Unchanged 7014 1671 0 Other-Triad Screening questionnaire Low-Income Mothers
Other-Mini Group Screening questionnaire
Other-Focus Group Screening questionnaire
Other-Confidentiality Agreement
Other-Confidentiality Agreement
Other-Consent Form
HUSSC 2012 Unchanged 3000 2166 0 Other-FNS-780 2012 HUSSC Bronze-Silver Application
Other-FNS 779 - 2012 HUSSC Gold-Gold Award of Distinction Application Award of Distinction Application 05222012
Other-TN Enrollment Form
Healthy School Environment Unchanged 4308 764 0 Other-Screening Questionnaire
Other-Parent - Screening Questionnaire
Other-Teacher - Screening Questionnaire
Other-Principal - Screening Questionnaire
Other-FSM - Screening Questionnaire
Other-Student - Focus Group Moderator Guide
Other-Parent - Focus Group Moderator Guide
Other-Teacher - Focus Group Moderator Guide
Other-Principal - Focus Group Moderator Guide
Other-FSM - Focus Group Moderator Guide
Other-Security Agreement - Adults
Other-Security Agreement - Parent of Children in Focus Group
Other-Consent Form
MyPlate Unchanged 16 10 0 Other-Attachment A - Teacher Letter_Response Form_Consent Form
Other-Attachment C: State Agency (FS Staff) Consent Forms
Other-Attachment F - Moderator's Guide for Teachers_Grades 1-6
Other-Attachment G - Educator Journal for Teachers_Grades 1-6
Other-Attachment H - Moderator's Guide for Food Service Staff
MyPlate Parent/Student REV Unchanged 180 98 0 Other-Attachment B - Parent Letter_Response Form_Consent Form for Parent_Consent Form for Student_ENGLISH_SpanishApril20
Other-Attachment D1 - Pre-Test Survey Instrument for Students_March13r
Other-Attachment D2 - Post-Test Survey Instrument for Students_March13r
Other-Attachment E - Moderator's Guide for Parent Focus Group_MyPlate at Home Handout_ENGLISHMarch_13r
Parent/Student REV 2 New 400 122 0 Other-B - Parent Letter_Survey_Consent Form_FINAL
Other-D - Student Pre-Survey_FINAL
Other-D2 - Student_Post-Survey_FINAL
Other-H - Parent InDepth Interview Guide_FINAL
Request Approval to Perform Research for Team Nutrition Posters for Elementary and Middle School New 264 50 0 Other-B_FNS Screener_Food Service Directorincentive.doc
Other-E_FNS Discussion Guide_Food Service Directors
Other-I_Agreement on Security of Comments_Food Service Directors.doc
Request Approval to Perform Research for Team Nutrition Posters for Elementary and Middle School New 5736 867 0 Other-A_FNS Screener_Student Focus Groupsincentive.doc
Other-C_FNS Discussion Guide_Elementary School.doc
Other-D_FNS Discussion Guide_Middle School.doc
Other-F_USDA CLN 1 Elementary Poster Prototypes.pdf
Other-F_USDA CLN 2 Middle School Poster Prototypes.pdf
Other-G_Agreement on Security of Comments.doc
Other-H_Parent Consent Formincentive.doc
State Agencies (Prinicpal & Teachers) REV 2 New 33 25 0 Other-A - Teacher Letter_Survey_Consent Form_FINAL
Other-C - Food Service Staff Letter _Survey_Consent Form_FINAL
Other-F - Teacher Post-Survey_FINAL
Other-G - Teacher InDepth Interview Guide_FINAL
Other-I - Food Service Staff Post-Survey_FINAL
Other-J - Food Service Staff InDepth Interview Guide_FINAL
Other-E - Educator Journal _FINAL (2)
Team Nutrition Curriculum (I/H) Unchanged 540 100 0 Other-Student Pretest
Other-Student Posttest
Other-Parent-Caregiver Posttest
Other-Distrib Parent-Caregiver Posttest
Team Nutrition Curriculum (State Agencies: Teachers & Foodservice Staff) Unchanged 51 6 0 Other-Protocol for Administration of Student Pretest
Other-.Protocol for Administration of Student Posttest
Other-Teacher Posttest Interview Guide & Reporting Form
Other-Teacher Implementation Log 1
Other-Teacher Implementation Log 2
Other-Teacher Implementation Log 3
Other-Teacher Implementation Log 4
Other-Teacher Implementation Log 5
Other-Teacher Implementation Log 6
Other-Teacher Implementation Log 7
Other-Teacher Implementation Log 8
Other-Teacher Implementation Log 9
Other-Teacher Implementation Log 10
Other-Teacher Implementation Log 11
Other-FSM Posttest Survey
Other-FSM Posttest Survey Protocol
Team Nutrition Curriculum Messages for 5 & 6th Grades (SA) Unchanged 21 36 0 Other-Teacher Letter Teacher Respnse Teacher Consent
Other-Teacher Agreement of Security Comments
Other-Moderator Guide for Teacher
Team Nutrition Gardens Formative Research Unchanged 735 154 0 Other-Focus Group Moderator Guide
Team Nutrtition Curriculum Messages for 5 & 6th Grades (I/H) Unchanged 1080 167 0 Other-Attachment C
Other-Attachment D
Other-Attachment E
Other-Attachment F
Other-Attachment G
Other-Attachment H
Other-Non-Respondent Place Holder
Testing the Modified FNS Core Nutrition Messages for Spanish-Speaking Audiences New 413 208 0 Other-Attachment A - Focus Group Screening Questionnaire
Other-Attachment B1 - All Child Feeding Practices Hanouts SPANISH
Other-Attachment C1 - Whole Grain Messages and Supporting Content Handouts SPA
Other-Attachment C2 - Milk Messages and Supporting Content Handouts SPANISH
Other-Attachment D1 - Whole Grain Messages and Supporting Content Handout SPAN
Other-Attachment D2 - Milk Messages and Supporting Content Handout SPANISH - 2
Other-Attachment D3 - Fruit-Vegetable-Availability-Accessibility Handout SPANI
What You Can Do for School Wellness Communication Tools Testing Unchanged 4308 763 0 Form and Instruction NA NA
Form and Instruction NA NA
Form and Instruction NA NA
Form and Instruction NA NA
Form and Instruction NA NA
Form and Instruction NA NA
Form and Instruction NA NA
Form and Instruction NA NA
Form and Instruction NA NA
Form and Instruction NA NA
Form and Instruction NA NA
Form and Instruction NA NA
Form and Instruction NA NA
Form and Instruction NA NA
Zero Income (I/H) Unchanged 250 60 0 Other-Attachment A1 - Interview Guide - English
Other-Attachment A2 - SPANISH INTERVIEW PROTOCOL FOR ZERO INCOME STUDY
Other-Attachment B - Participant Consent Form - 1-23-12
Other-Attachment B1 - Zero Income Participant Interview Consent Form Spanish - 1-26-12
Other-Attachment E - recruitment - telelphone script for SNAP participant2 - 1-26-12
Other-Attachment E1 - recruitment - telelphone script for SNAP participant2 - spanish - 1-26-12
Zero Income (SA) Unchanged 12 20 0 Other-Recruitment Letter to states
Instruction
Other-Recruitment script for States2
Total Burden Actually Used for Information Collections Under Currently Approved ICR: 66361 21287 0  
Total Burden Currently Requested for Information Collections Under Currently Approved ICR: 0 0 0  
To view an IC, click on IC Title