Farmers Market Consumer Survey

Evaluation of Childhood Obesity Prevention and Control Initiative: New York City Healthy Bucks Program

Documents and Forms

Document Name Document Type
Farmers Market Consumer Survey Form
Farmers Market Consumer Survey Appendix G-1 Consumer Survey_01.21.10.doc Form
Appendix G-2 Consumer Fact Sheet_01.21.10.doc Fact Sheet for Farmers Market Consumers IC Document

Information Collection (IC) Details

IC Title:	Farmers Market Consumer Survey	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	none	Farmers Market Consumer Survey	Appendix G-1 Consumer Survey_01.21.10.doc		No	No	Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,300	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	2,300	2,300
Annual IC Time Burden (Hours)	268	268
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Fact Sheet for Farmers Market Consumers	Appendix G-2 Consumer Fact Sheet_01.21.10.doc	04/01/2010

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