Information Collection Request

Healthy Incentives Pilot Evaluation

ICR 201105-0584-001 · OMB 0584-0561 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Appendix J - Analysis Plan.pdf Supplementary Document Uploaded 2011-05-06 Available
Appendix H - TWG Eval Design & Study Plan.pdf Supplementary Document Uploaded 2011-05-06 Repair queued
Appendix I3 - IRB and confidentiality.doc Supplementary Document Uploaded 2011-05-06 Available
Appendix I2 - IRB Approval Letter.pdf Supplementary Document Uploaded 2011-05-06 Available
Appendix I1 - Abt-Westat IAA.pdf Supplementary Document Uploaded 2011-05-06 Available
Appendix G2 - NASS comments.doc Supplementary Document Uploaded 2011-05-05 Available
HIP_OMB_SSB 11-5-24.docx Supporting Statement B Uploaded 2011-05-24 Available
HIP_OMB_SSA 11-5-24.doc Supporting Statement A Uploaded 2011-05-24 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
197621 State and Local Agencies Other-Round 1 Massachusetts Executive Interview Guide New
197619 Business (For- and Not-for-Profit) Other-Round 1 EBT Contractor (ACS) Interview Guide New
197618 Non-Responders (Business-for and not-for Profit) Other-Non-responses New
197617 Non-Responders (State Agencies) Other-Non-responses New
197616 Non Responders (Individual/Households) Other-Non Responders New
197607 Parents-Minor Surveys Other-Survey New

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
08/31/2014 36 Months From Approved
8,257 0 0
4,832 0 0
0 0 0





table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 8,257 0 0 8,257 0 0
Annual Time Burden (Hours) 4,832 0 0 4,832 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No