OMB Number 0584-0474
Expiration Date: XX/XX/XXXX
Public reporting burden for this collection of information is estimated to average five minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information including suggestions for reducing burden to: U.S. Department of Agriculture, Food and Nutrition services, Office of Research, Nutrition and Analysis, Room 1014, (0584-0474), Alexandria, VA 22302. Do not return completed form to this address.
The following information will be added to the USDA National Hunger Clearinghouse Database, an online resource that provides information about food assistance to the public. Please complete this form and return it to Hunger Free America.