Information Collection

Impact Evaluation Instruments

IC 190543 under ICR 200908-0584-004 · OMB 0584-0554.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0554 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
APPENDIX A. Data Collection Instruments for Impact Evaluation-SNAP-Ed I-English_Spanish.doc	Other-Questionnaire-English_Spanish

IC Title:

Impact Evaluation Instruments

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Questionnaire-English_Spanish			APPENDIX A. Data Collection Instruments for Impact Evaluation-SNAP-Ed I-English_Spanish.doc		No		Paper Only

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,154

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	4,223	4,223
Annual IC Time Burden (Hours)	1,184	1,184
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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