SEBTC - Households

Evaluation of the Impact of the Household-Based Summer Demonstrations on Food Insecurity Among Children (SEBTC)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0559 can be found here:

Documents and Forms

Document Name Document Type
Appendix A English baseline instrument 3 15 Final.doc Other-Baseline Questionnaire - Engli
Appendix A Spanish baseline instrument 3 15 11 final.doc Other-Appendix A :Spanish baseline i
Appendix B English Follow-Up instrument 3 16 11 Final.doc Other-Appendix B: English Follow-Up
Appendix B Follow-Up questionnaire SPANISH (3-16-11) Final.doc Other-Appendix B Follow-Up questionn
Advance Letter Baseline Combined_REV Final.doc Advance Letter Baseline Combined IC Document
Appendix K Participant Consent Language 2-8-2011.docx Consent Telephone Script (I/H) IC Document
Advance Letter Baseline Combined_REV(SPANISH) Final.docx Advance Letter Baseline Combined_REV(SPANISH) Final.docx IC Document
Advance Letter_FollowUp_Control_Eng_v1 Final.docx Advance Letter_FollowUp_Control_Eng IC Document
Advance Letter_FollowUp_Control_Spanish_v3 Final.docx Advance Letter_FollowUp_Control_Spanish IC Document
Advance Letter_FollowUp_Treatment_Eng_v1 Final.docx Advance Letter_FollowUp_Treatment_Eng IC Document
Advance Letter_FollowUp_Treatment_Spanish_v3 Final.docx Advance Letter_FollowUp_Treatment_Spanish IC Document

Information Collection (IC) Details

IC Title:	SEBTC - Households	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	Available Electronically?	Electronic Capability
Other-Baseline Questionnaire - English & Spanish	Appendix A English baseline instrument 3 15 Final.doc	No	Paper Only
Other-Appendix A :Spanish baseline instrument	Appendix A Spanish baseline instrument 3 15 11 final.doc	No	Paper Only
Other-Appendix B: English Follow-Up instrument	Appendix B English Follow-Up instrument 3 16 11 Final.doc	No	Paper Only
Other-Appendix B Follow-Up questionnaire SPANISH	Appendix B Follow-Up questionnaire SPANISH (3-16-11) Final.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: 10,667	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	21,334	21,334
Annual IC Time Burden (Hours)	15,167	15,167
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Advance Letter Baseline Combined	Advance Letter Baseline Combined_REV Final.doc	03/17/2011
Consent Telephone Script (I/H)	Appendix K Participant Consent Language 2-8-2011.docx	02/08/2011
Advance Letter Baseline Combined_REV(SPANISH) Final.docx	Advance Letter Baseline Combined_REV(SPANISH) Final.docx	03/17/2011
Advance Letter_FollowUp_Control_Eng	Advance Letter_FollowUp_Control_Eng_v1 Final.docx	03/17/2011
Advance Letter_FollowUp_Control_Spanish	Advance Letter_FollowUp_Control_Spanish_v3 Final.docx	03/17/2011
Advance Letter_FollowUp_Treatment_Eng	Advance Letter_FollowUp_Treatment_Eng_v1 Final.docx	03/17/2011
Advance Letter_FollowUp_Treatment_Spanish	Advance Letter_FollowUp_Treatment_Spanish_v3 Final.docx	03/17/2011

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