Information Collection

Impact Evaluation Instruments - Households

IC 190543 under ICR 201012-0584-001 · OMB 0584-0554.

⚠️ Notice: This information collection may be referencing outdated material.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

2012-02-14 - No material or nonsubstantive change to a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appendix A Impact Evaluation Data Collecting Instrument MSUE 3 16 11.doc	Other-Questionnaire - Michigan
Appendix A. Impact Evaluation Data Collecting Instrument UKCES 3.16.11.doc	Other-Questionnaire - KY
Appendix A. Impact Evaluation Data Collecting Instruments INN 3.16.11.doc	Other-Questionnaire - PA
APPENDIX A. Data Collection Instruments for Impact Evaluation INN Spanish Part 1.docx	Other-Survey Instruments for the Iow
APPENDIX A. Data Collection Instruments for Impact Evaluation INN Spanish Part 2.docx	Other-Survey: Instruments for the Io
APPENDIX A. Data Collection Instruments for Impact Evaluation INN English Part 3 1-3-2011 PRAB comments.docx	Other-Survey: Instruments for the Io
APPENDIX A. Data Collection Instruments for Impact Evaluation INN Spanish Part 4.docx	Other-Survey: Instruments for the Io
APPENDIX A. Data Collection Instruments for Impact Evaluation INN Spanish Part 5.docx	Other-Survey: Instruments for the Io
APPENDIX H. Cover Letters, Recruitment Letters and other St SLO 2.1.11.docx APPENDIX H. Households Cover Letters, Recruitment Letters and other	IC Document
APPENDIX E. Statistical Methods for Impact Evaluation_final.docx APPENDIX E. Statistical Methods for Impact Evaluation	IC Document
APPENDIX F. Data Collection Methods for Impact Evaluation_f.docx APPENDIX F. Data Collection Methods for Impact Evaluation	IC Document
APPENDIX H. Cover Letters, Recruitment Letters and other St SLO 2.1.11.docx Appendix H - Cover Letters, Recruitment Letters and other	IC Document
APPENDIX E. Statistical Methods for Impact Evaluation_final.docx APPENDIX E. Statistical Methods for Impact Evaluation	IC Document
APPENDIX F. Data Collection Methods for Impact Evaluation_f.docx APPENDIX F. Data Collection Methods for Impact Evaluation	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Impact Evaluation Instruments - Households

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Electronic Capability
Other-Questionnaire - Michigan	Appendix A Impact Evaluation Data Collecting Instrument MSUE 3 16 11.doc	No	Paper Only
Other-Questionnaire - KY	Appendix A. Impact Evaluation Data Collecting Instrument UKCES 3.16.11.doc	No	Paper Only
Other-Questionnaire - PA	Appendix A. Impact Evaluation Data Collecting Instruments INN 3.16.11.doc	No	Paper Only
Other-Survey: Instruments for the Iowa Nutrition Network Impact Evaluationï¿½Spanish Version	APPENDIX A. Data Collection Instruments for Impact Evaluation INN English Part 3 1-3-2011 PRAB comments.docx	No	Paper Only
Other-Survey: Instruments for the Iowa Nutrition Network Impact Evaluationï¿½Spanish Version	APPENDIX A. Data Collection Instruments for Impact Evaluation INN Spanish Part 2.docx	No	Paper Only
Other-Survey: Instruments for the Iowa Nutrition Network Impact Evaluationï¿½Spanish Version	APPENDIX A. Data Collection Instruments for Impact Evaluation INN Spanish Part 5.docx	No	Paper Only
Other-Survey: Instruments for the Iowa Nutrition Network Impact Evaluationï¿½Spanish Version	APPENDIX A. Data Collection Instruments for Impact Evaluation INN Spanish Part 4.docx	No	Paper Only
Other-Survey Instruments for the Iowa Nutrition Network Impact Evaluationï¿½Spanish Version	APPENDIX A. Data Collection Instruments for Impact Evaluation INN Spanish Part 1.docx	No	Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,928

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	Previously Approved
Annual Number of Responses for this IC	7,491	3,268	4,223
Annual IC Time Burden (Hours)	1,554	370	1,184
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
APPENDIX H. Households Cover Letters, Recruitment Letters and other	APPENDIX H. Cover Letters, Recruitment Letters and other St SLO 2.1.11.docx	03/02/2011
APPENDIX E. Statistical Methods for Impact Evaluation	APPENDIX E. Statistical Methods for Impact Evaluation_final.docx	03/03/2011
APPENDIX F. Data Collection Methods for Impact Evaluation	APPENDIX F. Data Collection Methods for Impact Evaluation_f.docx	03/03/2011
Appendix H - Cover Letters, Recruitment Letters and other	APPENDIX H. Cover Letters, Recruitment Letters and other St SLO 2.1.11.docx	06/09/2011
APPENDIX E. Statistical Methods for Impact Evaluation	APPENDIX E. Statistical Methods for Impact Evaluation_final.docx	06/09/2011
APPENDIX F. Data Collection Methods for Impact Evaluation	APPENDIX F. Data Collection Methods for Impact Evaluation_f.docx	06/09/2011

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