Attachment I
OMB Control # 0584-0524
Expiration Date: 04/30/2013
OMB BURDEN STATEMENT:
According to the Paperwork Reduction Act of 1995, no persons are
required to respond to a collection of information unless it
displays a valid OMB control number. The valid OMB control number
for this information collection is 0584-0524. The time required to
complete this information collection is estimated to average 5
minutes per response, including time to review instructions, search
existing data resources, gather the data needed, and complete and
review the information collection.
USDA Food and Nutrition Service
Agreement on Security of Comments for District Food Service Directors
I, __________________________(print name), agree to keep all information shown and discussed during the USDA interview in which I am participating in the strictest confidence.
I agree not to discuss, publish, or otherwise divulge any information I am exposed to, in whole or in part, in any manner or form.
Signed:___________________________ Dated: ____________________
Your comments will be kept secure and only used for research purposes except as otherwise required by law. Your name will not be divulged in any reports of these interviews.
FNS Team Nutrition Poster Testing Formative Research
Attachment I: Agreement on Security of Comments – Food Service Directors
| File Type | application/msword |
| File Title | USDA NON-DISCLOSURE |
| Author | Tech Services |
| Last Modified By | Ellen Bartlett |
| File Modified | 2013-02-06 |
| File Created | 2013-02-06 |