Information Collection

Local Food Promotion Program (State)

IC 223522 under ICR 201608-0581-001 · OMB 0581-0240.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0581-0240 can be found here:

Documents and Forms

Document Name Document Type
Local Food Promotion Program (State) Form and Instruction
Request for Applications LFPP Request for Applications 8-18-16.pdf www.ams.usda.gov Form and Instruction
Application Components FMPP-LFPP Application Components.docx www.ams.usda.gov Form and Instruction
Project Beneficiaries Questionnaire Project Beneficiaries Questionnaire 8-17-16.docx www.ams.usda.gov Form and Instruction
AMS-33 Agreement Face Sheet AMS-33 Agreement Face Sheet 8-17-16.pdf www.ams.usda.gov Form and Instruction
Accounting System & Financial Capability Questionnaire Accounting System Financial Capability Questionnaire 8-17-16.docx www.ams.usda.gov Form and Instruction
Confirmation of Match Confirmation of Match 8-17-16.docx www.ams.usda.gov Form and Instruction
Grant terms & Conditions of Award (Reading) LFPP Grant Terms and Conditions 8-18-16.pdf www.ams.usda.gov Form and Instruction
Peer Reviewer Application & Qualification Form Peer Reviewer Application Form.xls www.ams.usda.gov Form and Instruction
AMS-34 AMS Conflict of Interest & Confidentiality Statement for AMS-34 AMS Conflict of Interest and Confidentiality Statement 8-17-16.pdf www.ams.usda.gov Form and Instruction
Consensus Scoresheet & Comments Consensus Scoresheet.xlsx www.ams.usda.gov Form and Instruction
Individual Reviewer Scoresheet Individual Reviewer Scoresheet.xlsx www.ams.usda.gov Form and Instruction
AMS Worksheet to Accompany each SF-270 Request AMS Worksheet to Accompany each SF-270 Request 8-17-16.xlsx www.ams.usda.gov Form and Instruction
Interim Performance Report LFPP Interim Performance Report 8-18-16.docx www.ams.usda.gov Form and Instruction
Final Performance Report LFPP Final Performance Report 8-18-16.docx www.ams.usda.gov Form and Instruction
Registration with SAM.gov (screenshot) SAM.gov Screen Shot.pdf www.SAM.gov Form and Instruction
HUD Form 50153 HUD Promise Zone Certification Form HUD Promise Zone Certification Form 50153.pdf Form and Instruction
Request for Grant Amendment Example.pdf Request for Grant Amendment (Narrative) IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Local Food Promotion Program (State)	Agency IC Tracking Number:

Is this a Common Form? No		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
Form and Instruction	None	Request for Applications	LFPP Request for Applications 8-18-16.pdf	www.ams.usda.gov	Yes	Yes	Fillable Fileable
Form and Instruction	None	Application Components	FMPP-LFPP Application Components.docx	www.ams.usda.gov	Yes	Yes	Fillable Fileable
Form and Instruction	None	Project Beneficiaries Questionnaire	Project Beneficiaries Questionnaire 8-17-16.docx	www.ams.usda.gov	Yes	Yes	Fillable Fileable
Form and Instruction	AMS-33	Agreement Face Sheet	AMS-33 Agreement Face Sheet 8-17-16.pdf	www.ams.usda.gov	Yes	Yes	Fillable Fileable
Form and Instruction	None	Accounting System & Financial Capability Questionnaire	Accounting System Financial Capability Questionnaire 8-17-16.docx	www.ams.usda.gov	Yes	Yes	Fillable Fileable
Form and Instruction	None	Confirmation of Match	Confirmation of Match 8-17-16.docx	www.ams.usda.gov	Yes	Yes	Fillable Fileable
Form and Instruction	None	Grant terms & Conditions of Award (Reading)	LFPP Grant Terms and Conditions 8-18-16.pdf	www.ams.usda.gov	Yes	Yes	Fillable Fileable
Form and Instruction	None	Peer Reviewer Application & Qualification Form	Peer Reviewer Application Form.xls	www.ams.usda.gov	Yes	Yes	Fillable Fileable
Form and Instruction	AMS-34	AMS Conflict of Interest & Confidentiality Statement for Grant Reviewers	AMS-34 AMS Conflict of Interest and Confidentiality Statement 8-17-16.pdf	www.ams.usda.gov	Yes	Yes	Fillable Fileable
Form and Instruction	None	Consensus Scoresheet & Comments	Consensus Scoresheet.xlsx	www.ams.usda.gov	Yes	Yes	Fillable Fileable
Form and Instruction	None	Individual Reviewer Scoresheet	Individual Reviewer Scoresheet.xlsx	www.ams.usda.gov	Yes	Yes	Fillable Fileable
Form and Instruction	None	AMS Worksheet to Accompany each SF-270 Request	AMS Worksheet to Accompany each SF-270 Request 8-17-16.xlsx	www.ams.usda.gov	Yes	Yes	Fillable Fileable
Form and Instruction	None	Interim Performance Report	LFPP Interim Performance Report 8-18-16.docx	www.ams.usda.gov	Yes	Yes	Fillable Fileable
Form and Instruction	None	Final Performance Report	LFPP Final Performance Report 8-18-16.docx	www.ams.usda.gov	Yes	Yes	Fillable Fileable
Form and Instruction	None	Registration with SAM.gov (screenshot)	SAM.gov Screen Shot.pdf	www.SAM.gov	Yes	Yes	Fillable Fileable
Form and Instruction	HUD Form 50153	HUD Promise Zone Certification Form	HUD Promise Zone Certification Form 50153.pdf		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Economic Development

Subfunction: Business and Industry Development

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 158	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	1,731	1,731
Annual IC Time Burden (Hours)	4,388	4,388
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Request for Grant Amendment (Narrative)	Request for Grant Amendment Example.pdf	09/13/2016

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