Information Collection

Elderly & Working Poor

IC 193210 under ICR 201005-0584-003 · OMB 0584-0558.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0558 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appendix A Screener for Working Poor Final 10-5-2010.docx	Other-Telephone Screener
Appendix B Screener for Elderly Final 10-5-2010.docx	Other-Telephone Screener
Appendix E Focus Group Discussion Protocol Final 10-5-2010.docx	Other-Focus Group Guide
Appendix I Focus Group Protocol Spanish Final 10-5-2010.docx	Other-Focus Group Guide - Spanish
Appendix F Recruitment Script Working Poor Spanish Final 10-5-2010.docx	Other-Recruitment Script Working Poo
Appendix C Focus Group Reminder Letter 6-10-10.docx Reminder Telephone Script	IC Document
Appendix D Focus Group Reminder Call.docx Reminder Call - Spanish	IC Document
Appendix G Focus Group Reminder Letter Spanish.docx Reminder Letter - Spanish	IC Document

IC Title:

Elderly & Working Poor

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	Instrument File	Available Electronically?	Electronic Capability
Other-Recruitment Script Working Poor - Spanish	Appendix F Recruitment Script Working Poor Spanish Final 10-5-2010.docx	No	Paper Only
Other-Telephone Screener	Appendix A Screener for Working Poor Final 10-5-2010.docx	No	Paper Only
Other-Telephone Screener	Appendix B Screener for Elderly Final 10-5-2010.docx	No	Paper Only
Other-Focus Group Guide	Appendix E Focus Group Discussion Protocol Final 10-5-2010.docx	No	Paper Only
Other-Focus Group Guide - Spanish	Appendix I Focus Group Protocol Spanish Final 10-5-2010.docx	No	Paper Only

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,200

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	1,200	1,200
Annual IC Time Burden (Hours)	195	195
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Reminder Telephone Script	Appendix C Focus Group Reminder Letter 6-10-10.docx	06/10/2010
Reminder Call - Spanish	Appendix D Focus Group Reminder Call.docx	06/09/2010
Reminder Letter - Spanish	Appendix G Focus Group Reminder Letter Spanish.docx	06/10/2010

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