Information Collection

CNPP Qualitative Nutrition Quiz Research

IC 242753 under ICR 202001-0503-001 · OMB 0503-0024.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0503-0024 can be found here:

Documents and Forms

Document Name Document Type
FNS Attachment A-1 USDA Quiz Screener7-22-2020.docx Other-Screener
FNS Handout 1 StartSimpleQuizFinal.pdf Other-Handout
A-11 USDA FNS Clearance Customer Service Template.docx FNS A-11 CX Generic Clearance Template IC Document
FNS Attachment B-1 Confidentiality Agreement.docx FNS Attachment B IC Document
FNS Attachment C-1 USDA Quiz Focus Group Guide.docx FNS Attachment C Focus Group Guide IC Document
FNS Attachment D-1 Consent Form.docx FNS Attachment D Consent Form IC Document
FNS Attachment E-1 Focus Group Confirmation Form.docx FNS Attachment E Focus Group Confirmation Form IC Document
Webpage 1 MyPlate.Gov_QuizResultsPage.pdf Webpage My Plate Quiz Result Page IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	CNPP Qualitative Nutrition Quiz Research	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-Screener			FNS Attachment A-1 USDA Quiz Screener7-22-2020.docx		Yes	Yes	Fillable Fileable
Other-Handout			FNS Handout 1 StartSimpleQuizFinal.pdf		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 320	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	320	320
Annual IC Time Burden (Hours)	193	193
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
FNS A-11 CX Generic Clearance Template	A-11 USDA FNS Clearance Customer Service Template.docx	07/22/2020
FNS Attachment B	FNS Attachment B-1 Confidentiality Agreement.docx	07/22/2020
FNS Attachment C Focus Group Guide	FNS Attachment C-1 USDA Quiz Focus Group Guide.docx	07/22/2020
FNS Attachment D Consent Form	FNS Attachment D-1 Consent Form.docx	07/22/2020
FNS Attachment E Focus Group Confirmation Form	FNS Attachment E-1 Focus Group Confirmation Form.docx	07/22/2020
Webpage My Plate Quiz Result Page	Webpage 1 MyPlate.Gov_QuizResultsPage.pdf	07/22/2020

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