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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Consumer Research for Nutrition Education and Promotion Activities
Agency IC Tracking Number:
IC Status:
Unchanged
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
FNS-781
Team Nutrition School Enrollment Form
FNS-781 - Team Nutrition.pdf
http://healthymeals.nal.usda.gov/hsmrs/hussc
Yes
Yes
Fillable Fileable Signable
Form and Instruction
FNS-779
Gold Application for Recognizing Excellence in Nutrition and Physical Activity
FNS-779.pdf
No
Fillable Printable
Form and Instruction
FNS-780
Bronze/Silver Recognizing Excellence in Nutrition and Physical Activity
FNS-780.pdf
No
Fillable Printable
Form and Instruction
FNS-790
Hunger Champions Nomination Form
FNS-790.pdf
http://www.fns.usda.gov//snap/outreach/default.htm
Yes
Yes
Fillable Fileable
Form and Instruction
FNS-791
Promising Practices Submission Form
FNS-791.pdf
http://www.fns.usda.gov/snap/outreach/default.htm
Yes
Yes
Fillable Fileable
Form and Instruction
FNS-793
FNS Core Nutrition Messags Feedback Form
FNS-793.pdf
No
Fillable Printable
Other-Screening Guide
Administrators Screener USDA Food Program.doc
No
Paper Only
Other-Questionnaire
CNP Benchmark Screen Shots USDA Food Program.doc
http://www.globaltestmarket.com/survey/s.phtml?sn=151310&demo=1&lang=E&secid=daecaa
Yes
Yes
Fillable Fileable Signable
Other-Questionnaire
CNP Screen Shots USDA Food Program.doc
http://www.globaltestmarket.com/survey/s.phtml?sn=151310&demo=1&lang=E&secid=daecaa
Yes
Yes
Fillable Fileable Signable
Other-Screener Guide
CNP Screener USDA Food Program.doc
No
Paper Only
Other-Confidentiality Agreements
Confidentiality_Agreements_USDA Food Program.doc
No
Paper Only
Other-Script
IDI_Script_USDA Food Program.doc
No
Paper Only
Other-Parent Guide
Parents_Guides_USDA Food Program.doc
No
Paper Only
Other-Partner Screener
Partner_Screener_USDA Food Program.doc
No
Paper Only
Other-Recruitment Screener
Recruitment_Screeners_USDA Food Program.doc
No
Paper Only
Other-Teacher Benchmark
Teacher Benchmark Q USDA Food Program.doc
No
Paper Only
Other-Teacher Benchmark
Teacher Benchmark Screen Shots USDA Foods.doc
http://mrd.saynation.com/MRDSAYNATION/QSurvey/?UID=panelist&SID=S195377173683131&TEST=1
Yes
Yes
Fillable Fileable Signable
Other-Teacher Screener
Teacher Screener - USDA Food Program.doc
No
Paper Only
Other-Teacher Guide
Teacher_Guide_USDA Food Program.doc
No
Paper Only
Form and Instruction
FNS 792
Golden Grocer Award Nomination Form
FNS-792.pdf
http://www.fns.usda.gov/snap/outreach/default.htm
Yes
Yes
Fillable Fileable Signable
Form
FNS 803
User Response Form
FNS 803 Wed Site User Response Form (ESPH Educators).doc
Eatsmartplayhard@usda.gov
Yes
Yes
Fillable Fileable Signable
Form
FNS 804
Healthy Lifestyle User Response
FNS 804 Healthy Lifestyle Web User Response Form.doc
Eatsmartplayhard@usda.gov
Yes
Yes
Fillable Fileable Signable
Form
FNS 805
Kids User Response
FNS-805 Kids Web Site User Response Form.doc
Eatsmartplayhard@usda.gov
Yes
Yes
Fillable Fileable Signable
Form
FNS 813
Power Partner Commitment
FNS-813 Power Partner Commitment Form.doc
Eatsmartplayhard@usda.gov
Yes
Yes
Fillable Fileable Signable
Form
FNS 807
Power Panther Request and Agreement
FNS-807 Power Panther Request and Agreement Form.doc
No
Fillable Fileable
Form
FNS 808
Event Feedback (Power Panther)
FNS 808- Event Feedback Form (Power Panther).doc
Eatsmartplayhard@usda.gov
Yes
Yes
Fillable Printable
Form
FNS 809
Promote and Support Breastfeeding Feedback
FNS 809 Promote and support breasfeeding feedback form.doc
http://www.fns.usda.gov/ora/SNAP/TakeAction/TakeAction.htm
Yes
Yes
Fillable Fileable Signable
Form
FNS 810
Promote Fruits and Vegetables in Your Workplace
FNS 810 Promote Fruits and Vegetables in Your Workplace & Community.doc
http://www.fns.usda.gov/ora/SNAP/TakeAction/TakeAction.htm
Yes
Yes
Fillable Printable
Form
FNS 811
User Response Card
FNS -811 User Response Card-LYFFF.doc
http://www.fns.usda.gov/snap/nutrition_education/
Yes
Yes
Fillable Printable
Form
FNS 812
Activity Kit User Response Form
FNS-812 ACTIVITY KIT USER RESPONSE FORM(ESLS).doc
http://www.fns.usda.gov/snap/nutrition_education/
Yes
Yes
Fillable Fileable Signable
Form and Instruction
FNS 779
Gold/Gold Award of Distinction Application
779.pdf
No
Paper Only
Form and Instruction
FNS 780
Bronze/Silver Award Application
FNS-780.pdf
No
Paper Only
Form
FNS 816
Level I Feedback
FNS-816.pdf
http://www.fns.usda.gov/fns/outreach.htm.
Yes
Yes
Fillable Fileable Signable
Form
FNS 817
Level III Feedback Form
FNS-817.pdf
http://www.fns.usda.gov/fns/outreach.htm.
Yes
Yes
Fillable Fileable Signable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Income Security
Subfunction:
Food and Nutrition Assistance
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
10,000
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
2 %
Requested
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
38,000
0
0
0
0
38,000
Annual IC Time Burden (Hours)
14,000
0
0
0
0
14,000
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Reminder Email
Reminder_Email_Benchmark_USDA Food Program.doc
03/04/2010
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.