Information Collection

Parents-Minor Surveys

IC 197607 under ICR 201105-0584-001 · OMB 0584-0561.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0561 can be found here:

2012-02-09 - 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 B1 - Round 1 Study Participant and Primary Shopper-English.doc	Other-Survey
Appendix B2 - Round 2 Study Participant and Primary Shopper-English.doc	Other-Survey
Appendix B3 - Round 3 Study Participant and Primary Shopper-English.doc	Other-Survey
Appendix B4 Round 1 Study Participant and Primary Shopper Survey-Spanish.doc	Other-Survey
Appendix B5 - Round 2 Study Participant and Primary Shopper-Spanish.doc	Other-Survey
Appendix B6 - Round 3 Study Participant and Primary Shopper-Spanish.doc	Other-Survey
Appendix C - AMPM Screenshots.doc www.ars.usda.gov/Services/docs.htm?docid=7710#what	Other-Screenshots
Appendix D1 - FG Participant Telephone Recruitment Script-English.doc	Other-D1 - Focus Group Participant T
Appendix D2 - FG Participant Consent Form-English.doc	Other-Participant Consent Form
Appendix D3- FG Protocol-English.doc	Other-Moderator Guide
Appendix D4 - FG Data Sheet-English.doc	Other-Demographics Questionnaire
Appendix D5 - FG Participant Incentive Receipt Form-English.doc	Other-Incentive Acknowledgement Rece
Appendix A 1-Round 1 Advanced Letter to Study Participants-English.doc A 1-Round 1 Advanced Letter to Study Participants-English	IC Document
Appendix A 2-Round 1 Advanced Letter to Parents of Minors-English.doc A 2-Round 1 Advanced Letter to Parents of Minors-English	IC Document
Appendix A 3-Round 2 Advanced Letter to Study Participants-English.doc A 3-Round 2 Advanced Letter to Study Participants-English	IC Document
Appendix A 4-Round 2 Advanced Letter to Parents of Minors-English.doc A 4-Round 2 Advanced Letter to Parents of Minors-English	IC Document
Appendix A 5-Round 3 Advanced Letter to Study Participants-English.doc A 5-Round 3 Advanced Letter to Study Participants-English	IC Document
Appendix A 6-Round 3 Advanced Letter to Parents of Minors-English.doc A 6-Round 3 Advanced Letter to Parents of Minors-English	IC Document
Appendix A 7-Round 1Advanced Letter to Study Participants-Spanish.doc A 7-Round 1 Advanced Letter to Study Participants-Spanish	IC Document
Appendix A 8-Round 1 Advanced Letter to Parents of Minors-Spanish.doc A 8-Round 1 Advanced Letter to Parents of Minors-Spanish	IC Document
Appendix A 9-Round 2 Advanced Letter to Study Participants-Spanish.doc A 9-Round 2 Advanced Letter to Study Participants-Spanish	IC Document
Appendix A 10-Round 2 Advanced Letter to Parents of Minors-Spanish.doc A 10-Round 2 Advanced Letter to Parents of Minors-Spanish	IC Document
Appendix A 11-Round 3 Advanced Letter to Study Participants-Spanish.doc A 11-Round 3 Advanced Letter to Study Participants-Spanish	IC Document
Appendix A 12-Round 3 Advanced Letter to Parent of Minors-Spanish.doc A 12-Round 3 Advanced Letter to Parent of Minors-Spanish	IC Document
Appendix B7 - In person script-English.doc B7 - In person script-English	IC Document
Appendix B8 - Voicemail script-English.doc B8 - Voicemail script-English	IC Document
Appendix B9 - Refusal strategy and script-English.doc B9 - Refusal strategy and script-English	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Parents-Minor Surveys

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Survey	Appendix B1 - Round 1 Study Participant and Primary Shopper-English.doc		No		Paper Only
Other-Survey	Appendix B2 - Round 2 Study Participant and Primary Shopper-English.doc		No		Paper Only
Other-Survey	Appendix B3 - Round 3 Study Participant and Primary Shopper-English.doc		No		Paper Only
Other-Survey	Appendix B4 Round 1 Study Participant and Primary Shopper Survey-Spanish.doc		No		Paper Only
Other-Survey	Appendix B5 - Round 2 Study Participant and Primary Shopper-Spanish.doc		No		Paper Only
Other-Survey	Appendix B6 - Round 3 Study Participant and Primary Shopper-Spanish.doc		No		Paper Only
Other-Screenshots	Appendix C - AMPM Screenshots.doc	http://www.ars.usda.gov/Services/docs.htm?docid=7710#what	Yes	Yes	Fillable Fileable
Other-D1 - Focus Group Participant Telephone Recruitment Script: English	Appendix D1 - FG Participant Telephone Recruitment Script-English.doc		No		Paper Only
Other-Participant Consent Form	Appendix D2 - FG Participant Consent Form-English.doc		No		Paper Only
Other-Moderator Guide	Appendix D3- FG Protocol-English.doc		No		Paper Only
Other-Demographics Questionnaire	Appendix D4 - FG Data Sheet-English.doc		No		Paper Only
Other-Incentive Acknowledgement Receipt	Appendix D5 - FG Participant Incentive Receipt Form-English.doc		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: 2,915

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 10 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	5,916	5,916
Annual IC Time Burden (Hours)	4,577	4,577
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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