Individuals - SNAP Participants

Public Burden Statement:  An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number.  The OMB control number for this project is 0584-0547.  Public reporting burden for this collection of information is estimated to be 108.25 hours per response including the time for participating in the interviews and providing the extant data collection.  Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to:  U.S. Department of Agriculture, Food and Nutrition Services, Office of Research and Analysis, 3101 Park Center Drive, Room 1014, Alexandria, VA, 22302, ATTN: Rosemarie Downer

In-Person Screener

(SNAP Non-Participants who may be eligible)

RECRUIT 25-30 PEOPLE TO SEAT 10

Hello. My name is ____________________, and I'm from Mathematica Policy Research, Inc., a private research organization. We are conducting a study for the U.S. Department of Agriculture on the Supplemental Nutrition Assistance Program or SNAP, formerly known as the Food Stamp Program, in [STATE]. We are looking for some people to participate in our study.

Let me assure you that this is not a sales presentation, and at no time during our discussion will you be asked to donate money. We are simply interested in your opinions. Today, I'm just going to ask some easy questions. Then, there will be an in-person discussion group on a different day. If you are invited to attend, you will receive $25 in cash for your time and will receive a light meal and refreshments.

May I ask you a few questions?

¨ Yes CONTINUE

¨ No.............................................................................................THANK AND TERMINATE

RECORD GENDER:

¨ Female ¨ Male

RECRUIT A MIX OF GENDERS

1. Do you currently receive SNAP benefits for yourself or for anyone else in your household?

¨ Yes THANK AND TERMINATE

¨ No

2. How many people are in your household?

NUMBER_____________________________

3. Recruiter: Find appropriate gross income limit for household size $_________

People in Household	Gross Monthly Income Limits
1	$x,xxx
2	$x,xxx
3	$x,xxx
4	$x,xxx
5	$x,xxx
6	$x,xxx
7	$x,xxx
8	$x,xxx
For each additional person, add:	+$xxx

Would you say your monthly household income, including income from jobs and income from public assistance programs, is greater than $[Gross Income Limit], less than $[Gross Income Limit] or about the same as $[Gross Income Limit]?

• Greater than $[Gross Income Limit] THANK AND TERMINATE

• About the same as $[Gross Income Limit] THANK AND TERMINATE

• Less than $[Gross Income Limit] CONTINUE WITH SCREENER

4. Do you or does anyone in your household have a bank account?

• Yes (ASK Q. 5 BELOW)

• No (GO TO NEXT SECTION)

5. Think about the total amount in all bank accounts for your household. Would you say the total value in all checking accounts is more than $2,000, about $2,000, or less than $2,000?

• Greater than $2,000 THANK AND TERMINATE

• About the same as $2,000 THANK AND TERMINATE

• Less than $2,000 CONTINUE WITH SCREENER

The next set of questions will help us get a diverse group for the discussion.

1. Which of the following categories includes your age? (READ & RECORD)

¨ 18-24

¨ 25-34

¨ 35-44

¨ 45-59

¨ 60+

RECRUIT A MIX OF AGES

2. Do you consider yourself to be of Hispanic or Latino/a origin or do you consider yourself not to be of Hispanic or Latino/a origin?

PROBE: Hispanic or Latino/a origin includes, Mexican American or Chicano/a, Puerto Rican, Cuban, or some other Hispanic origin or descent

¨ Hispanic or Latino/a origin

¨ Not Hispanic or Latino/a origin

3. What race or races do you consider yourself? (CHECK ALL THAT APPLY)

¨ American Indian or Alaska Native

¨ Asian

¨ Black/African-American

¨ Hispanic or Latino

¨ Native Hawaiian or other Pacific Islander

¨ White

4. What language are you most comfortable speaking?

¨ English GO TO Q5

¨ Spanish GO TO Q5

¨ Other CONTINUE WITH 4a

4a. How well would you say you understand and speak English?

¨ Not at all THANK AND TERMINATE

¨ Not well THANK AND TERMINATE

¨ Well

¨ Very well

5. Finally, could you briefly tell me about your last food shopping experience?

(PROBE: What did you purchase?)

__________________________________________________________________________

___________________________________________________________________

___________________________________________________________________

THE ABOVE QUESTION IS INCLUDED TO DETERMINE THE RESPONDENT’S LEVEL OF ARTICULATENESS AND THE ABILITY AND WILLINGNESS TO TALK OPENLY. IF THE RESPONDENT HESITATES IN ANSWERING THE QUESTION OR HAS A POOR COMMAND OF ENGLISH, THEN DO NOT ISSUE THE INVITATION. END THE CONVERSATION POLITELY AND THANK THEM FOR THEIR TIME.

INVITATION

Thank you for answering all of my questions. As part of our study, we are conducting a discussion group related to the SNAP Program in [STATE]. The purpose of the discussion group is to learn about your experiences in order to make the program better and more appealing to potential clients. As mentioned earlier, we will not try to sell you anything or use your name for other purposes than this research. All information collected in connection with this study will be kept strictly confidential and used only for research purposes. Your name will not be used in reporting the results of the study and your answers will not affect your eligibility for any programs. We will destroy all of the contact information we have about you, such as your name, number, and address, after the discussion group is complete.

The group will consist of approximately 9 other people, such as yourself, and a discussion leader. You are invited to attend the group that will take place at [TIME] on [DATE]. It will be held at ____________________________ [GIVE LOCATION]. The group will last about one and one-half hours. Nothing will be sold at the session and you will receive $25 in cash as a token of our appreciation. A light meal and refreshments will be served. Would you be able to attend?

¨ YES………………CONTINUE WITH “MORE INFORMATION” ON NEXT PAGE

¨ NO………………………..………GO TO “TRANSPORTATION” ON NEXT PAGE

TRANSPORTATION AND CHILDCARE

Is lack of transportation or childcare the main reason you wouldn’t be able to participate in the discussion?

¨ YES……………………..… CONTINUE WITH “MORE INFORMATION” BELOW

¨ NO……………………………………….............……………………….TERMINATE

IF TRANSPORTATION IS PROBLEM: Perhaps you can ask a family member, neighbor, or friend to drive you to the discussion group. We can reimburse transportation expenses of up to $5. This would be in addition to the $25 incentive you will receive for participating in the discussion group.

IF CHILDCARE IS PROBLEM: Perhaps you can ask a family member or friend to babysit. We can reimburse child care expenses of up to $15. This would be in addition to the $25 incentive you will receive for participating in the discussion group.

Now that you have this information, would you be able to attend?

¨ YES……………………………………………..……………………...........CONTINUE

¨ NO…………………………………………………..................………….TERMINATE

MORE INFORMATION

Please make sure that if you need glasses or other corrective lenses that you bring them to the session. There may be some materials that you will have to read and/or look at.

So that we can start and end on time, please plan to arrive about 15 minutes early to meet the other participants and have refreshments.

We are counting on your participation, so please be sure to call us as soon as possible if you find you can't attend so we can find a replacement.

Before we finish, let me make sure I have the correct spelling of your name and also get your address and phone number(s) so that we can send you a confirmation letter with directions and give you a reminder phone call.

FIRST AND LAST NAME: ________________________________________________

HOME PHONE: ________________________________________________________

ADDRESS ____________________________________________________________

PERSONAL E-MAIL ADDRESS: ___________________________________________

WORK PHONE:_________________________________________________________

Thank you very much for your time today. We look forward to getting the chance to listen to your opinions and learn from your experiences at the discussion group. We’ll see you there!

Recruiter’s name _______________________________ Date____________________

Confirmed by __________________________________ Date_____________________

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