Information Collection

USDA Foods Household Fact Sheets Feedback Survey

IC 229571 under ICR 201605-0584-004 · OMB 0584-0611.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0611 can be found here:

Documents and Forms

Document Name Document Type
Fact Sheet Survey Questions 122617.docx www.wufoo.com Other-USDA Foods Household Fact Shee
FNS Fast Track Clearance Submission - Household Fact Sheets Feedback Survey.docx Fast Track Clearance Request - USDA Foods Household Fact Sheets Feedback Survey IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	USDA Foods Household Fact Sheets Feedback Survey	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-USDA Foods Household Fact Sheets Feedback Survey			Fact Sheet Survey Questions 122617.docx	www.wufoo.com	Yes	Yes	Fillable Fileable

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,162	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3,162	3,162
Annual IC Time Burden (Hours)	458	458
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Fast Track Clearance Request - USDA Foods Household Fact Sheets Feedback Survey	FNS Fast Track Clearance Submission - Household Fact Sheets Feedback Survey.docx	12/26/2017

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.