Appendix C-Sources of questions

OMB Appendix C

Sources of Questions for the Household Instruments

The survey questions in the Spring Baseline and Summer Follow-up Questionnaires for the Summer EBT for Children evaluation were taken from and/or modified from questions in national food and nutrition surveys. The questions on participation in the new summer benefit program were modified from questions on participation in the Supplemental Nutrition Assistance Program (SNAP) and the Supplemental Nutrition Program for Women, Infants, and Children (WIC). Table A.1 summarizes the sources of the questions by section in the questionnaires.

Table A.1. Sources of Survey Questions for the Summer EBT for Children Evaluation

Section	Content	Source of Questions
A. Introduction	General introduction to study and identification of most knowledgeable adult to be the respondent	Modified language from previous studies for FNS/USDA with approved IRB language for this study
B. Household characteristics	Household composition, number of children, adults, and ages of school-age children	HIA2009, SNDA III, NHFAPS
C. Child demographics	Target child’s age, sex, and race/ ethnicity	SNDA III
D. Child dietary behaviors	Eating breakfast; consumption of fruits and vegetables; whole grains (cereals, breads); sugar-sweetened beverages; milk and cheese; grain-based desserts; eggs; peanut butter; and canned fish. Items are included in the Dietary Guidelines for Americans (DGA) and/or contained in the WIC Food Package.	SNDA III for breakfast; 2009-10 NHANES Multifactor Diet Screener. The food items included will allow for estimation of healthful items recommended by the DGA (fruits and vegetables; low-fat milk and dairy products; whole grains) or included in the WIC Food Package, and discretionary items (sugar sweetened beverages; grain-based desserts) that should be limited (per the DGA). A question was added to assess the quality of the reported food consumption at the suggestion of the developers of the NHANES Multifactor Diet Screener at the National Cancer Institute/NIH.
E. Child program participation	Target child’s participation in school meals, backpack program, after school snack or meal program, and Summer Food Service Program	SNDA III, NHFAPS
F. Household food security	Levels of food security and food insecurity among adults and children in the household	Standard 18-item instrument used in the CPS
G. Household shopping and eating behavior	Food expenditures at supermarkets/ grocery stores, fast food and other restaurants and frequency of eating away from home	NHANES Flexible Consumer Behavior Questionnaire (also used in FoodAPS)
H. Household program participation	Participation in WIC, SNAP, emergency food (food banks, kitchens) and summer EBT program	1996 National Food Stamp Program Study, HIA2009
I. Caregiver demographics	Relationship to target child, age, race/ethnicity, marital status, education level, employment status (adults), annual and last month’s income, working refrigerator, any disabled person in household	NHANES, SNDA III
J. Additional contact information	Name, telephone number and relationship for three other contacts

CPS = Current Population Survey

NHFAPS = National Household Food Acquisition and Purchase Study (FoodAPS)

NHANES = National Health and Nutrition Examination Survey

SNDA III = Third School Nutrition and Dietary Assessment Study

HIA2009 = Hunger in America 2009