State, Local County SNAP Agencies

Performance Standards and Reporting SNAP Modernization Initiatives

Documents and Forms

Document Name Document Type
Appendix G -ELECTRONIC SURVEY.doc www.SNAP.mathematica-mpr.com Other-Electronic Survey Screen Shots
Appendix K - SNAP Staff Phone Interview.doc Other-Telephone Interview
Appendix E - Request for Performance Data.doc Instruction
Appendix F - Survey Access Instructions.doc www.SNAP.mathematica-mpr.com Instruction
Non-Response Placeholder.doc Other-Non Response Placeholder
Appendix H - SURVEY REMINDER CALL SCRIPT.doc Appendix H: SURVEY REMINDER CALL SCRIPT IC Document
Appendix I - PHONE INTERVIEW SCHEDULING CALL SCRIPT.doc Appendix I: PHONE INTERVIEW SCHEDULING CALL SCRIPT IC Document
Appendix J - PERFORMANCE DATA REMINDER CALL.doc Appendix J: PERFORMANCE DATA REMINDER CALL IC Document
Appendix M - SITE VISIT INTERVIEW TOPICS.doc Appendix M - SITE VISIT INTERVIEW TOPICS IC Document
Appendix B - RESPONDENT INVITATION LETTERS.doc Appendix B - RESPONDENT INVITATION LETTERS IC Document

Information Collection (IC) Details

IC Title:	State, Local County SNAP Agencies	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Electronic Survey Screen Shots	Appendix G -ELECTRONIC SURVEY.doc	www.SNAP.mathematica-mpr.com	Yes	Yes	Fillable Fileable Signable
Other-Telephone Interview	Appendix K - SNAP Staff Phone Interview.doc		No		Paper Only
Instruction	Appendix E - Request for Performance Data.doc		No		Paper Only
Instruction	Appendix F - Survey Access Instructions.doc	www.SNAP.mathematica-mpr.com	Yes	No	Paper Only
Other-Non Response Placeholder	Non-Response Placeholder.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: 451	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 55 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,669	1,669
Annual IC Time Burden (Hours)	2,677	2,677
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Appendix H: SURVEY REMINDER CALL SCRIPT	Appendix H - SURVEY REMINDER CALL SCRIPT.doc	03/29/2010
Appendix I: PHONE INTERVIEW SCHEDULING CALL SCRIPT	Appendix I - PHONE INTERVIEW SCHEDULING CALL SCRIPT.doc	03/29/2010
Appendix J: PERFORMANCE DATA REMINDER CALL	Appendix J - PERFORMANCE DATA REMINDER CALL.doc	03/29/2010
Appendix M - SITE VISIT INTERVIEW TOPICS	Appendix M - SITE VISIT INTERVIEW TOPICS.doc	03/29/2010
Appendix B - RESPONDENT INVITATION LETTERS	Appendix B - RESPONDENT INVITATION LETTERS.doc	03/29/2010

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