View Information Collection (IC)
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View Information Collection (IC)
View Information Collection (IC)
IC Title:
HUSSC 2012
Agency IC Tracking Number:
IC Status:
New
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
Other-FNS-780 2012 HUSSC Bronze-Silver Application
rev062712 2012 HUSSC Bronze-Silver Application.doc
http://teamnutrition.usda.gov/healthierUS/index.html
Yes
Yes
Paper Only
Other-FNS 779 - 2012 HUSSC Gold-Gold Award of Distinction Application Award of Distinction Application 05222012
rev062712 2012 HUSSC Gold-Gold Award of Distinction Application.doc
http://teamnutrition.usda.gov/healthierUS/index.html
Yes
Yes
Paper Only
Other-TN Enrollment Form
Attachment C - TN Enrollment Form.doc
www.teamnutrition.usda.gov/healthierus/index.html
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:
3,000
Number of Respondents for Small Entity:
300
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
100 %
Approved
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
3,000
0
3,000
0
0
0
Annual IC Time Burden (Hours)
2,166
0
2,166
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
HUSSC Generic Clearance Justification
rev062612 HUSSC Justification Memo 6-25-12.doc
06/26/2012
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.